Provider Demographics
NPI:1942838875
Name:GREEN, JOHN ALVIN III
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALVIN
Last Name:GREEN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21595
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4112
Mailing Address - Country:US
Mailing Address - Phone:251-318-2678
Mailing Address - Fax:251-405-9900
Practice Address - Street 1:75 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3271
Practice Address - Country:US
Practice Address - Phone:251-471-7870
Practice Address - Fax:251-460-7923
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2783207R00000X
390200000X
AL2738208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program