MR. WALLACE MAXWELL GREEN PAC NPI 1306979059

NPI Information

NPI: 1306979059
Provider Name: MR. WALLACE MAXWELL GREEN, PAC
Classification: Psychiatry & Neurology - 2084N0400X
Entity Type: Individual

Specialization: Neurology

Address:
1275 HIGHWAY 54 W
STE.105
FAYETTEVILLE, GA
ZIP 30214
Phone: (770) 719-2965
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MR. Wallace Maxwell Green, PAC is a neurology psychiatry neurology in Fayetteville, GA. The provider is a Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. MR. Wallace Maxwell Green, PAC NPI is 1306979059. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1275 HIGHWAY 54 W
STE.105
FAYETTEVILLE, GA
ZIP 30214-549
Phone: (770) 719-2965
Fax: (770) 719-2963

The enumeration date for this NPI number is 3/13/2007 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084N0400X	Psychiatry & Neurology	Neurology	001827	GEORGIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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