Stephen Kelly Green, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIRO02560 Issued in GA

Practice address

4200 Wade Green Rd NW
Suite 27
Kennesaw, GA 30144-1237

Phone

(770) 427-2799

Fax

(770) 427-2243

NPI assigned

Jul 13, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  • NPI 1194357046
  NPD

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770508145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 WADE GREEN RD NW",
            "address_2": "SUITE 27",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301441237",
            "telephone_number": "770-427-2799",
            "fax_number": "770-427-2243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 WADE GREEN RD NW",
            "address_2": "SUITE 27",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301441237",
            "telephone_number": "770-427-2799",
            "fax_number": "770-427-2243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "STEPHEN",
        "middle_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIRO02560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Gray
• Zachary Paul Graziosi, RBT
• Great Start Development Center, LLC
• Angel Green
• Ashley Green
• Emily Greenlaw
• Neaveh Gregory
• Korica Griffin
• Shawtevais Keyann Griffin, BCBA
• Tachauncia N Griggs

• Chiropractor in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.