Dr Jackson Tucker Green, DDS is a medicare enrolled "Student In An Organized Health Care Education/training Program" provider in Memphis, Tennessee. His current practice location is
875 Union Ave, Memphis, Tennessee. You can reach out to his office (for appointments etc.) via phone at
(901) 448-1731.
Dr Jackson Tucker Green is licensed to practice in Arizona (license number D011416) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1902535495.
Healthcare Provider's Profile
| Full Name | Dr Jackson Tucker Green |
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| Gender | Male |
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| Speciality | Student In An Organized Health Care Education/training Program |
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| Location | 875 Union Ave, Memphis, Tennessee |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1902535495
- Provider Enumeration Date: 06/09/2022
- Last Update Date: 05/12/2025
Medicare PECOS Information:
- PECOS PAC ID: 8224483706
- Enrollment ID: I20231018003779
Medical Identifiers
Medical identifiers for Dr Jackson Tucker Green such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1902535495 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 1223G0001X | Dentist - General Practice | D011416 (Arizona) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | D011416 (Arizona) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jackson Tucker Green is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Jackson Tucker Green, DDS
7794 Kings College Ave Apt 382,
Germantown, TN 38138-2098
Ph: () - | Dr Jackson Tucker Green, DDS
875 Union Ave,
Memphis, TN 38163-2211
Ph: (901) 448-1731 |
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