Provider Demographics
NPI:1003918897
Name:WHITE, GREGORY P (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:P
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 28389
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424-8389
Mailing Address - Country:US
Mailing Address - Phone:423-800-0800
Mailing Address - Fax:423-402-9466
Practice Address - Street 1:105 LEE PARKWAY DR
Practice Address - Street 2:SUITE E
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6708
Practice Address - Country:US
Practice Address - Phone:423-800-0800
Practice Address - Fax:423-402-9466
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000017977208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621613625001OtherTRICARE SOUTHERN REGION
TN3095022OtherCIGNA MEDICARE OF TN
TNP00081775OtherRR MEDICARE
TNTN0102OtherJOHN DEERE HEALTH
TN3095022OtherTENNCARE/MEDICAID
TN4063781OtherBC/BS OF TN
TN4063781OtherTENNCARE SELECT
TNG19483OtherUPIN