Provider Demographics
NPI:1023731056
Name:GREEN, MARTHA (RDN)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 SPRINGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-2113
Mailing Address - Country:US
Mailing Address - Phone:843-240-0101
Mailing Address - Fax:
Practice Address - Street 1:964 HIGH HOUSE RD # 3014
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-3574
Practice Address - Country:US
Practice Address - Phone:919-263-4278
Practice Address - Fax:919-578-1503
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL006232133V00000X
SC1319133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered