Provider Demographics
NPI:1366680035
Name:RICHARD L. GREGG, D.C., P.C.
Entity Type:Organization
Organization Name:RICHARD L. GREGG, D.C., P.C.
Other - Org Name:NORCROSS HEALTH & PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-446-1555
Mailing Address - Street 1:5180 JIMMY CARTER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1618
Mailing Address - Country:US
Mailing Address - Phone:770-446-1555
Mailing Address - Fax:678-646-1969
Practice Address - Street 1:5180 JIMMY CARTER BLVD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1618
Practice Address - Country:US
Practice Address - Phone:770-446-1555
Practice Address - Fax:678-646-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR004822261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center