Provider Demographics
NPI:1770841314
Name:GREEN, CHRISTINA DENISE (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DENISE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:DENISE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3 MEDICAL PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3722
Mailing Address - Country:US
Mailing Address - Phone:501-776-6249
Mailing Address - Fax:501-574-7901
Practice Address - Street 1:3 MEDICAL PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3722
Practice Address - Country:US
Practice Address - Phone:501-776-6249
Practice Address - Fax:501-574-7901
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARE-8669207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty