Provider Demographics
NPI:1548211857
Name:MANCINI, GREGORY JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOHN
Last Name:MANCINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 ALCOA HWY STE 285
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1528
Mailing Address - Country:US
Mailing Address - Phone:865-305-9620
Mailing Address - Fax:865-525-3460
Practice Address - Street 1:1934 ALCOA HWY STE 285
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1528
Practice Address - Country:US
Practice Address - Phone:865-305-9620
Practice Address - Fax:865-525-3460
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40807208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3816963Medicaid
TN3816963Medicare PIN
TN3816963Medicaid