Provider Demographics
NPI:1780147710
Name:GREEN, MAX ELLIOT (MD)
Entity type:Individual
Prefix:DR
First Name:MAX
Middle Name:ELLIOT
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5670 PEACHTREE DUNWOODY RD STE 1200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4791
Mailing Address - Country:US
Mailing Address - Phone:404-255-9100
Mailing Address - Fax:404-257-7171
Practice Address - Street 1:5670 PEACHTREE DUNWOODY RD STE 1200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4791
Practice Address - Country:US
Practice Address - Phone:404-255-9100
Practice Address - Fax:404-257-7171
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME148608207R00000X
GA92926208M00000X
FLTRN29328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine