Provider Demographics
NPI:1891708111
Name:DEMOTTS, GREGORY L (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
Last Name:DEMOTTS
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:PO BOX 3889
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3889
Mailing Address - Country:US
Mailing Address - Phone:423-230-2100
Mailing Address - Fax:423-230-2112
Practice Address - Street 1:142 MEADE AVE
Practice Address - Street 2:
Practice Address - City:NICKELSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24271-2108
Practice Address - Country:US
Practice Address - Phone:276-479-2201
Practice Address - Fax:276-479-3314
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN013154207Q00000X
VA0101031217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4175553Medicaid
VA037069OtherANTHEM BLUE CROSS BLUE SH
TN3706155OtherMEDICARE GROUP PIN
VA5609933Medicaid
TN4175553Medicaid
VA5609933Medicaid