Provider Demographics
NPI:1043394968
Name:GREGG, FRED MARSHALL III (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:MARSHALL
Last Name:GREGG
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 GLENWOOD DR
Mailing Address - Street 2:SUITE 892
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1163
Mailing Address - Country:US
Mailing Address - Phone:423-624-3937
Mailing Address - Fax:423-629-6505
Practice Address - Street 1:725 GLENWOOD DR
Practice Address - Street 2:SUITE 892
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1163
Practice Address - Country:US
Practice Address - Phone:423-624-3937
Practice Address - Fax:423-629-6505
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD012037207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNC84183Medicare UPIN
TN3000003Medicare ID - Type Unspecified