Susan A Greene, APRN-BC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

100566 Issued in GA

Practice address

901 Bombay LN
Roswell, GA 30076-5829

Phone

(770) 664-1920

Fax

(888) 388-9622

NPI assigned

Jun 26, 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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA, NC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lifesource of North CarolinaGroup PAC ID 7416132428, shared by 9 NPIs, 172 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Nurse Practitioner

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.

• Lifesource of North Carolina

  • General Practice Physician
  • Rome, GA
  • NPI 1962940817
  Medicare reassignment NPD
• Community Care Health Network LLC

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1619368842

  GA

  Medicare reassignment NPD
• Lifesource of North Carolina

  • Internal Medicine Physician
  • Wilmington, NC
  • NPI 1811286156
  Medicare reassignment NPD
• Lifesource Prime Inc

  • Family Medicine Physician
  • Wilmington, NC
  • NPI 1598533275
  Medicare reassignment NPD
• Lifesource of North Carolina

  • Psychologist
  • Milton, FL
  • NPI 1730648288

  Psychiatric/Mental Health

  NPD
• Lifesource Prime Inc

  • Family Medicine Physician
  • Richmond, VA
  • NPI 1548124159
  NPD
• Avenia Behavioral Management, Inc

  • Psychiatry Physician
  • Marietta, GA
  • NPI 1457395733
  NPD (past)

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774396800000",
    "number": "1982631040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 OLD MOBILE RD",
            "city": "MC CAYSVILLE",
            "state": "GA",
            "postal_code": "305551950",
            "telephone_number": "706-492-5274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 BOMBAY LN",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765829",
            "telephone_number": "770-664-1920",
            "fax_number": "888-388-9622"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3205 Randall Pkwy Ste 105",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284032565",
            "country_code": "US",
            "telephone_number": "910-742-9243",
            "fax_number": "888-746-1787",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1345 Redmond Cir NW",
            "address_purpose": "LOCATION",
            "city": "Rome",
            "state": "GA",
            "postal_code": "301651307",
            "country_code": "US",
            "telephone_number": "910-742-9243",
            "fax_number": "888-746-1787",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREENE",
        "first_name": "SUSAN",
        "middle_name": "A",
        "credential": "APRN-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-26",
        "last_updated": "2026-03-25",
        "certification_date": "2026-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "GA",
            "license": "100566",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NC",
            "license": "5023924",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054554063A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "83-02313",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Greater Atlanta Integrative Pediatrics
• Ashley Green
• Leah Green
• William Shelton Green, ATC
• Kathleen O'Neill Greene, PT
• Victoria Greene, RBT
• Greenline Medical Corporation
• Mark Greenspan, MSPT
• Jodi M. Greenwald, M.D.
• Theresia Lynn Greer, LMT

• Gerontology Nurse Practitioner in Roswell, GA
• Providers in Roswell, GA by specialty
• Gerontology Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2026; 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.