Provider Demographics
NPI:1134195860
Name:HINES, GREGORY ALAN (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:HINES
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 926
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-0926
Mailing Address - Country:US
Mailing Address - Phone:931-762-9416
Mailing Address - Fax:931-762-0634
Practice Address - Street 1:1311 S LOCUST AVE STE 102
Practice Address - Street 2:SUITE 102
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4054
Practice Address - Country:US
Practice Address - Phone:931-762-9416
Practice Address - Fax:931-762-0634
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD37386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3729164OtherMEDICARE PTAN
TN3729164Medicaid
TN3729164OtherMEDICARE PTAN