Provider Demographics
NPI:1609097666
Name:GREGORY, PAUL MELVIN JR (NP-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MELVIN
Last Name:GREGORY
Suffix:JR
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1830 S HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4014
Mailing Address - Country:US
Mailing Address - Phone:336-765-0463
Mailing Address - Fax:336-768-9452
Practice Address - Street 1:1830 S HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4014
Practice Address - Country:US
Practice Address - Phone:336-765-0463
Practice Address - Fax:336-768-9452
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0050-02296363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health