Basic Information
| Provider Information | |||||||||
| NPI: | 1033438189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREEN | ||||||||
| FirstName: | LIZINA | ||||||||
| MiddleName: | BLESSING | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3381 PHILLIS BLVD | ||||||||
| Address2: | |||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295771560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434570177 | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 S MORGAN AVE | ||||||||
| Address2: | |||||||||
| City: | ANDREWS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295102959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432645253 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2010 | ||||||||
| LastUpdateDate: | 12/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34145 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME106714 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.