Provider Demographics
NPI:1801532726
Name:GREGG, SPENCER MALONE (PA-C)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:MALONE
Last Name:GREGG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:350 OLD HICKORY BLVD APT 4002
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-3040
Mailing Address - Country:US
Mailing Address - Phone:601-606-2165
Mailing Address - Fax:
Practice Address - Street 1:2323 21ST AVE S STE 400
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4930
Practice Address - Country:US
Practice Address - Phone:615-861-1114
Practice Address - Fax:615-965-4498
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN4987363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical