Dr. Kimberly J Green, D.O
General Practice in Alpharetta, GA. Individual provider (NPI-1).
NPI number1720174873
StatusActive
Last updated in NPPESJul 26, 2013
Details
- NPI
- 1720174873
- Entity type
- Individual (NPI-1)
- Name
- Dr. Kimberly J Green
- Credential
- D.O
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 5, 2006
- Last updated
- Jul 26, 2013
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - GENERAL PRACTICE
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208D00000X | General Practice | 58478 | GA | Yes |
| 208D00000X | General Practice | 2002456A | IN |
Practice location
1090 Cambridge SqSuite A
Alpharetta, GA 30009-1875
Phone 770-754-9880 · Fax 770-754-9881
Mailing address
1090 Cambridge SqSuite A
Alpharetta, GA 30009-1875
Phone 770-754-9880 · Fax 770-754-9881
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