Desiree Green

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

257 Martin Luther King Jr Dr
Eatonton, GA 31024-8033

Phone

(609) 792-0013

NPI assigned

Oct 18, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1697587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697587200000",
    "number": "1497537047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7108 S KANNER HWY",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349977462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 MARTIN LUTHER KING JR DR",
            "city": "EATONTON",
            "state": "GA",
            "postal_code": "310248033",
            "telephone_number": "609-792-0013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "DESIREE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-18",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Georgia CVS Pharmacy, L.L.C.
• Golden Links Healthcare LLC
• Stacey Lyn Gothard, MED CCC-SLP
• Grace and Mercy Life Coach, LLC
• Grace T. Duque-Dizon, MD, PC
• Greensboro Sports, Spine, &
• Eric Gregory, DC
• Taylor Ellen Hall, FNP
• Hannah Meigan Miller DMD LLC
• Harmony Hospice LLC

• All providers in Eatonton, GA
• Behavior Technician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; 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.