IndividualActive
Edward Green, MD
NPI 1073719803 · Diagnostic Radiology Physician · Jackson, MS
Provider details
- NPI number
- 1073719803
- Entity type
- Individual
- Primary specialty
- Diagnostic Radiology PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- Yes
- License
- 135313 (NC)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
969 Lakeland Dr
Jackson, MS 39216-4606
Phone: (601) 200-6162
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 23073
Jackson, MS 39225-3073
Registry dates
- Enumerated
- 2007-06-27
- Last updated
- 2022-10-06
- Certified
- 2022-10-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.