Provider Demographics
NPI:1821186222
Name:CHILDREY, GREGORY WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:WAYNE
Last Name:CHILDREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8700
Mailing Address - Street 2:425 HOSPITAL DR, STE 5
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-0012
Mailing Address - Country:US
Mailing Address - Phone:662-240-0095
Mailing Address - Fax:662-240-0096
Practice Address - Street 1:425 HOSPITAL DR
Practice Address - Street 2:SUITE 5
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1901
Practice Address - Country:US
Practice Address - Phone:662-240-0095
Practice Address - Fax:662-240-0096
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS08923207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS730-13919OtherBCBS OF ALABAMA
MS00014256Medicaid
MSB66060Medicare UPIN