Individual provider Active NPI

Roland H Green Jr., M.D.

  • Internal Medicine Physician
  • Evans, GA
National Provider Identifier
1477870749
Registry record updated May 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
296123-1 Issued in NY
Practice address
447 N Belair Rd
Ste 104
Evans, GA 30809-3091
Phone
(678) 386-6201
NPI assigned
Apr 27, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD19400 HI
Internal Medicine Physician 207R00000X 01089378A IN
Internal Medicine Physician 207R00000X MD463717 PA
Internal Medicine Physician 207R00000X 4301114090 MI
Internal Medicine Physician 207R00000X C159465 CA
Internal Medicine Physician 207R00000X MD190366 OR
Internal Medicine Physician 207R00000X DR.0062519 CO
Internal Medicine Physician 207R00000X ME138295 FL
Internal Medicine Physician 207R00000X R8749 TX
Internal Medicine Physician 207R00000X 071739 GA
General Practice Physician 208D00000X 071739 GA
Internal Medicine Physician 207R00000X 296123-1 NY Primary

Addresses

Primary practice location

447 N Belair Rd
Ste 104
Evans, GA 30809-3091

Mailing address

1120 15TH St
Augusta, GA 30912-0004
Phone (706) 721-3813

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C159465CAMDInternal Medicine Physician
DR.0062519COMDInternal Medicine Physician
ME138295FLMDInternal Medicine Physician
071739GAMDInternal Medicine Physician
MD19400HIMDInternal Medicine Physician
01089378AINMDInternal Medicine Physician
4301114090MIMDInternal Medicine Physician
296123-1NYMDInternal Medicine Physician
MD190366ORMDInternal Medicine Physician
R8749TXMDInternal Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1272326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558483200000",
    "number": "1477870749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 15TH ST",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309120004",
            "telephone_number": "706-721-3813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "447 N BELAIR RD",
            "address_2": "STE 104",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093091",
            "telephone_number": "678-386-6201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "ROLAND",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-27",
        "last_updated": "2019-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "HI",
            "license": "MD19400",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01089378A",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD463717",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301114090",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C159465",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD190366",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR.0062519",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME138295",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "R8749",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "071739",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "071739",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "296123-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evans, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.