Active NPI
Graham Green, DO
- General Practice Physician
- Jacsonville, NC
National Provider Identifier
1619733839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 0102209476
- Practice address
- Building As4021 Canal St
Jacsonville, NC 28540 - Phone
- (910) 449-6500
- NPI assigned
- Feb 26, 2024
- Last updated
- Aug 21, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 0102209476 | VA | Primary |
Addresses
Primary practice location
Building As4021 Canal St
Jacsonville, NC 28540
Mailing address
Building As4021 Canal St
Jacsonville, NC 28540
Phone (910) 449-6500
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
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0102209476 | VA | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787270400000",
"number": "1619733839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "BUILDING AS4021 CANAL ST",
"city": "JACSONVILLE",
"state": "NC",
"postal_code": "28540",
"telephone_number": "910-449-6500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "BUILDING AS4021 CANAL ST",
"city": "JACSONVILLE",
"state": "NC",
"postal_code": "28540",
"telephone_number": "910-449-6500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "GRAHAM",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-02-26",
"last_updated": "2026-08-21",
"certification_date": "2026-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "VA",
"license": "0102209476",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.