Provider Demographics
NPI:1508400037
Name:GREGORY, JAMES DARWIN SR
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DARWIN
Last Name:GREGORY
Suffix:SR
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 1:175 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:DRAKES BRANCH
Mailing Address - State:VA
Mailing Address - Zip Code:23937-2913
Mailing Address - Country:US
Mailing Address - Phone:434-315-4630
Mailing Address - Fax:
Practice Address - Street 1:175 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:DRAKES BRANCH
Practice Address - State:VA
Practice Address - Zip Code:23937-2913
Practice Address - Country:US
Practice Address - Phone:434-315-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)