Thomas A Green, D.C.
Individual provider Active NPI Chiropractor · Fitzgerald, GA
NPI 1861494718 · NPPES record last updated Jul 18, 2012
Key facts
- NPI
- 1861494718
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- CHIR004988 (GA)
- Practice address
- 321 W Central Ave
Fitzgerald, GA 31750-2441 - Phone
- (229) 423-2196
- NPI assigned
- Aug 11, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CHIR004988 | GA | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CHIR004988 | GA | Yes |
Addresses
Primary practice location
321 W Central Ave
Fitzgerald, GA 31750-2441
Mailing address
321 W Central Ave
Fitzgerald, GA 31750-2441
Phone (229) 423-2196
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000564154A | Medicaid | GA |
Other providers in Fitzgerald, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.