Justin Jermaine Green, HAIR LOSS SPECIALIST

Primary specialty

Prosthetics Case ManagementTaxonomy code 1744P3200X

License

126818 Issued in TN

Practice address

4412 Elvis Presley Blvd
Memphis, TN 38116-6408

Phone

(901) 830-9256

NPI assigned

Jul 13, 2018

Sex

Male

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

State licenses

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

{
    "created_epoch": "1531440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531440000000",
    "number": "1770069684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "436 CLARICE DR",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381094626",
            "telephone_number": "901-830-9256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4412 ELVIS PRESLEY BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381166408",
            "telephone_number": "901-830-9256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JUSTIN",
        "middle_name": "JERMAINE",
        "credential": "HAIR LOSS SPECIALIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-07-13",
        "last_updated": "2018-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1744P3200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist, Prosthetics Case Management",
            "state": "TN",
            "license": "126818",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglas Green Jr.
• Jackson Tucker Green, DDS
• Jammie D Green
• Jennifer Green
• Julia L Green, RN
• Laron Green
• Latoya L Green, DPT
• Lindsay Green, MD
• Melody D Green, MA
• Nadja Michelle Green

• Prosthetics Case Management in Memphis, TN
• Providers in Memphis, TN by specialty
• Prosthetics Case Management in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2018; 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.