Provider Demographics
NPI:1508814583
Name:GREGORY, ALEXIA M (MD)
Entity Type:Individual
Prefix:
First Name:ALEXIA
Middle Name:M
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3225 SHALLOWFORD RD.
Mailing Address - Street 2:BLDG 1300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062
Mailing Address - Country:US
Mailing Address - Phone:678-560-7160
Mailing Address - Fax:678-560-7185
Practice Address - Street 1:3225 SHALLOWFORD RD.
Practice Address - Street 2:BLDG 1300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062
Practice Address - Country:US
Practice Address - Phone:678-560-7160
Practice Address - Fax:678-560-7185
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2019-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA051137208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA532340111BMedicaid