Kimberly J Green, D.O

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

58478 Issued in GA

Practice address

1090 Cambridge SQ
Suite a
Alpharetta, GA 30009-1875

Phone

(770) 754-9880

Fax

(770) 754-9881

NPI assigned

Oct 5, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General PracticeAlso: Osteopathic Manipulative Medicine, Pain Management

Education

Philadelphia College of Osteopathic Medicine, 2000

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Greenline Medical Corporation

  • General Practice Physician
  • Roswell, GA
  • NPI 1073810453
  Medicare reassignment NPD Authorized official
• Acworth Pain Management Center Inc

  • Pain Clinic/Center
  • Acworth, GA
  • NPI 1235354218
  NPD (past)
• CF Health Management

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Gainesville, GA
  • NPI 1154579191
  NPD (past)
• Fairland Recovery Center

  • Substance Abuse Rehabilitation Facility
  • Rome, GA
  • NPI 1730954777
  NPD (past)
• Suwanee Pain Management Center Inc

  • Pain Clinic/Center
  • Suwanee, GA
  • NPI 1487878856
  NPD (past)
• The Pain Management Clinic of Woodstock

  • Specialist
  • Gainesville, GA
  • NPI 1134374259
  NPD (past)
• Eagle Medical Center

  • Internal Medicine Physician
  • Charlotte, NC
  • NPI 1245563352
  NPD (past)

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374796800000",
    "number": "1720174873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 CAMBRIDGE SQ",
            "address_2": "SUITE A",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300091875",
            "telephone_number": "770-754-9880",
            "fax_number": "770-754-9881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 CAMBRIDGE SQ",
            "address_2": "SUITE A",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300091875",
            "telephone_number": "770-754-9880",
            "fax_number": "770-754-9881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KIMBERLY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2013-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "58478",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IN",
            "license": "2002456A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Lynne Greeff, P.A.-C
• Green Apple Nutrition, Inc
• Green Haven Hospice and Palliative Care, LLC
• Anastasia Green, NP
• Brelynn Green
• Michelle Kho Green, PHARMD
• Jeremy Greenberg Wagner, MD
• Bernard Steven Greenberg, MD
• Tamara S Greene, M.D.
• Tiffani Greene

• General Practice Physician in Alpharetta, GA
• Providers in Alpharetta, GA by specialty
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.