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Edward Green, MD
Diagnostic Radiology Physician in Jackson, Mississippi
NPI 1073719803

Edward Green is a Diagnostic Radiology Physician based in Jackson, MS and is specialized in Diagnostic Radiology. Edward Green practices in Jackson, MS and has the professional credentials of MD. The NPI Number for Edward Green is 1073719803 and holds a License No. 135313 (Mississippi).

The current practice location address for Edward Green is 969 Lakeland Dr, Jackson, MS and can be reached out via phone at 601-200-6162.

Location: 969 Lakeland Dr, Jackson, MS, 39225-3073
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Provider Profile Details
NPI Number
1073719803
Provider Name
Edward Green
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
969 Lakeland Dr, Jackson, MS, 39225-3073
Phone Number
601-200-6162
Fax Number
Provider Enumeration Date
06/27/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
512I360002 01 MS PTAN
179024 05 AL
P01195515 01 MS RAILROAD MEDICARE PTAN
institution
Provider Business Practice Location Address Details
Address
969 Lakeland Dr
City
State
Zip
39216-4606
Phone Number
601-200-6162
Fax Number
person
Provider Business Mailing Address Details
Address
969 Lakeland Dr
City
State
Zip
39216-4606
Phone Number
601-200-6162
Fax Number
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Radiology
Speciality
Diagnostic Radiology
Taxonomy
License No.
135313 (North Carolina)
Definition
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
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