Provider Demographics
NPI:1972671428
Name:OLDS, GREGORY D (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:OLDS
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 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-497-5355
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:2200 E 3RD ST STE 200
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2745
Practice Address - Country:US
Practice Address - Phone:423-643-2500
Practice Address - Fax:423-305-7822
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083262207RG0100X
TN49152207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI462542110Medicaid
GO083262OtherCOMMERCIAL-COMMERCIAL NUMBER
100H264400OtherBLUE CROSS-BLUE CROSS
GO083262OtherCHAMPUS-CHAMPUS
0H26440041Medicare ID - Type Unspecified
GO083262OtherCHAMPUS-CHAMPUS