Provider Demographics
NPI:1265271027
Name:GREGORY, CEDRIC CHARLES JR
Entity type:Individual
Prefix:
First Name:CEDRIC
Middle Name:CHARLES
Last Name:GREGORY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 SCHILLER AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310
Mailing Address - Country:US
Mailing Address - Phone:330-524-6792
Mailing Address - Fax:
Practice Address - Street 1:588 SCHILLER AVE
Practice Address - Street 2:APT 2
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310
Practice Address - Country:US
Practice Address - Phone:330-524-6792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider