Provider Demographics
NPI:1336218379
Name:GREGORY, JAMES (M D)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:GREGORY
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 MOUNT SINAI RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3749
Mailing Address - Country:US
Mailing Address - Phone:706-278-9329
Mailing Address - Fax:706-281-2395
Practice Address - Street 1:606 MOUNT SINAI RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3749
Practice Address - Country:US
Practice Address - Phone:706-278-9329
Practice Address - Fax:706-281-2395
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0011347174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00045619HOtherDSPS
GAD40-020Medicare UPIN
GAGRP4194Medicare ID - Type UnspecifiedMEDICARE #