Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kelly D Green, MD

Individual provider Cardiovascular Disease Physician · NPI 1790909489

Kelly D Green, MD is an Interventional Cardiology in Jackson, Tennessee. Graduated from University of Tennessee, Hsc, College of Medicine in 2007, 19 years ago. Practices with Jackson Clinic PA, a 176-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Tennessee.

Years since qualifying
19
Trained at
University of Tennessee, Hsc, College of Medicine
Licensed in
TN
In the registry since
2007
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

145 Innovation Dr
Jackson, TN 38305-3019
Phone: (731) 422-0213
Fax: (731) 422-0409
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 700 W Forest Ave, Jackson, TN 38301-3937 — (731) 422-0347

Specialties & licences

Cardiovascular Disease Physician (primary) Taxonomy 207RC0000X · Licence 45891 (TN)
Internal Medicine Physician Taxonomy 207R00000X · Licence 45891 (TN)

Record details

NPI number1790909489
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 12, 2007
Last updated in NPPESOctober 25, 2023
Certification dateMarch 31, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERVENTIONAL CARDIOLOGY
Also practisesCARDIOVASCULAR DISEASE (CARDIOLOGY), INTERNAL MEDICINE
Medical schoolUNIVERSITY OF TENNESSEE, HSC, COLLEGE OF MEDICINE
Graduated 2007 (19 years in practice)
Group practice Jackson Clinic Pa — 176 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations9 on file with Medicare

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