Provider Demographics
NPI:1528388592
Name:CAIN, GREGORY BRIAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:BRIAN
Last Name:CAIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 HIGHWAY 411
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-4417
Mailing Address - Country:US
Mailing Address - Phone:423-442-2121
Mailing Address - Fax:
Practice Address - Street 1:3959 HIGHWAY 411
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-4417
Practice Address - Country:US
Practice Address - Phone:423-442-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1861363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant