Provider Demographics
NPI:1366761041
Name:GREEN, AMANDA HOPE (BS)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:HOPE
Last Name:GREEN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 CAVE RD
Mailing Address - Street 2:APT. 803
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1791
Mailing Address - Country:US
Mailing Address - Phone:931-241-1498
Mailing Address - Fax:
Practice Address - Street 1:201 UFFELMAN DR
Practice Address - Street 2:SUITE F
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2975
Practice Address - Country:US
Practice Address - Phone:931-920-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator