Provider Demographics
NPI:1821396854
Name:GREGORY, TIMOTHY M (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:GREGORY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 BIRCHTON ST
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7649
Mailing Address - Country:US
Mailing Address - Phone:404-886-9403
Mailing Address - Fax:678-352-0917
Practice Address - Street 1:1575 OLD ALABAMA RD STE 105
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2133
Practice Address - Country:US
Practice Address - Phone:404-721-4406
Practice Address - Fax:404-601-5101
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor