Provider Demographics
NPI:1831103746
Name:MOTLEY, GREGORY F (CRNA)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:F
Last Name:MOTLEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 SUNRISE PARK
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2345
Mailing Address - Country:US
Mailing Address - Phone:931-962-4061
Mailing Address - Fax:931-962-3343
Practice Address - Street 1:185 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2404
Practice Address - Country:US
Practice Address - Phone:931-962-4061
Practice Address - Fax:931-962-3343
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-027875367500000X
TNRN48452367500000X
TNAPN9030367500000X
TNAANA030545367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051555625Medicaid
TN3605800OtherMEDICAID OF TN
AL51526481OtherBCBS #
TN3605803OtherMEDICARE OF TN
TN0098646OtherBC/BS OF TN
ALR92272Medicare UPIN
TN3605800OtherMEDICAID OF TN