Provider Demographics
NPI:1609819291
Name:VINES, GREGORY F (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:F
Last Name:VINES
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 1:712 PROFESSIONAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-5138
Mailing Address - Country:US
Mailing Address - Phone:423-820-0432
Mailing Address - Fax:423-525-8795
Practice Address - Street 1:712 PROFESSIONAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-5138
Practice Address - Country:US
Practice Address - Phone:423-820-0432
Practice Address - Fax:423-525-8795
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38604207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3895386Medicaid
TN38953801Medicare PIN
TN103I083336Medicare PIN