Provider Demographics
NPI:1447382361
Name:GREGORY A HINES
Entity Type:Organization
Organization Name:GREGORY A HINES
Other - Org Name:FAMILY MEDICAL CENTER PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-762-9416
Mailing Address - Street 1:1311 S LOCUST AVE STE 102
Mailing Address - Street 2:PO BOX 926
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-4054
Mailing Address - Country:US
Mailing Address - Phone:931-762-9416
Mailing Address - Fax:931-762-0634
Practice Address - Street 1:1311 S LOCUST AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4040
Practice Address - Country:US
Practice Address - Phone:931-762-9416
Practice Address - Fax:931-762-0634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD37386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDE1190OtherRAILROAD MEDICARE
TN3729164Medicaid
TNDE1190OtherRAILROAD MEDICARE