Provider Demographics
NPI:1366747057
Name:GREEN, DAN PAUL (DPH)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:PAUL
Last Name:GREEN
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 SOMERSET DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-1704
Mailing Address - Country:US
Mailing Address - Phone:615-822-0722
Mailing Address - Fax:615-672-9505
Practice Address - Street 1:3012 HIGHWAY 31 W
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-8970
Practice Address - Country:US
Practice Address - Phone:615-672-3763
Practice Address - Fax:615-672-9505
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist