Provider Demographics
NPI:1861155368
Name:GREEN, MAGGIE BRAXTON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:BRAXTON
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:ANNE
Other - Last Name:BRAXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7425 LAUREL RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-3664
Mailing Address - Country:US
Mailing Address - Phone:850-363-6249
Mailing Address - Fax:
Practice Address - Street 1:915 GORDON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6699
Practice Address - Country:US
Practice Address - Phone:229-228-2948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59750183500000X
GAPDTM0001411835P2201X
GARPH032631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care