Provider Demographics
NPI:1952685166
Name:GREGG, TINA MAUK (DPH)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MAUK
Last Name:GREGG
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 STONEGATE DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7057
Mailing Address - Country:US
Mailing Address - Phone:205-699-7284
Mailing Address - Fax:205-699-3479
Practice Address - Street 1:16468 HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:AL
Practice Address - Zip Code:35043-8336
Practice Address - Country:US
Practice Address - Phone:205-678-9288
Practice Address - Fax:205-678-9291
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11654183500000X
TN7784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist