Provider Demographics
NPI:1578623914
Name:FANCHER, GREGORY NATHAN (MS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:NATHAN
Last Name:FANCHER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5400
Mailing Address - Country:US
Mailing Address - Phone:843-524-8899
Mailing Address - Fax:843-524-8179
Practice Address - Street 1:603 BARNWELL HWY
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:SC
Practice Address - Zip Code:29810-1905
Practice Address - Country:US
Practice Address - Phone:803-584-4636
Practice Address - Fax:803-584-5065
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC421504Medicaid
3340Medicare ID - Type Unspecified