Provider Demographics
NPI:1376503128
Name:GREGORY, SANDRA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LYNN
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:WINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3330 PRESTON RIDGE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4508
Mailing Address - Country:US
Mailing Address - Phone:770-350-0126
Mailing Address - Fax:770-350-6637
Practice Address - Street 1:3330 PRESTON RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4509
Practice Address - Country:US
Practice Address - Phone:770-255-7500
Practice Address - Fax:770-255-7501
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0573682085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA314129659CMedicaid
GA314129659CMedicaid
GAG13391Medicare UPIN