Provider Demographics
NPI:1295093383
Name:RODRICK R. GREGORY, M.D.,P.C.
Entity type:Organization
Organization Name:RODRICK R. GREGORY, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODRICK
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-363-1414
Mailing Address - Street 1:170 LOCKER RD
Mailing Address - Street 2:PO BOX 270
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-6000
Mailing Address - Country:US
Mailing Address - Phone:931-363-1414
Mailing Address - Fax:931-363-5743
Practice Address - Street 1:170 LOCKER RD
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-6000
Practice Address - Country:US
Practice Address - Phone:931-363-1414
Practice Address - Fax:931-363-5743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 319442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E79475Medicare UPIN