Green Terrace

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

GREEN TERRACE

Practice address

821 26TH Ave SE
Moultrie, GA 31768-6769

Phone

(229) 985-0905

Fax

(229) 890-8130

NPI assigned

Mar 28, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Thomas W Greene

Title

Owner

Phone

(229) 985-0905

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598884835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 26TH AVE SE",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686769",
            "telephone_number": "229-985-0905",
            "fax_number": "229-890-8130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 26TH AVE SE",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317686769",
            "telephone_number": "229-985-0905",
            "fax_number": "229-890-8130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN TERRACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GREENE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-985-0905",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00744818A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Gould, PA
• Matthew Adam Graham, MD
• Keith Woodward Gramling Jr., DO
• Justin Wayne Graves, LCSW
• Green Oaks Center
• David Michael Green, MD
• Ava Dawn Greene, FNP-C
• Jesse Nathan Greene
• Michael Brandon Griffin, PHARMD
• Sabrina Griffin, FNP-C

• Assisted Living Facility in Moultrie, GA
• Providers in Moultrie, GA by specialty
• Assisted Living Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.