Provider Demographics
NPI:1801982467
Name:GINN, GREGORY E (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:E
Last Name:GINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:965 RIDGE LAKE BLVD
Mailing Address - Street 2:#102
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:901-227-4068
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:1995 HIGHWAY 51 SOUTH
Practice Address - Street 2:SUITE 203
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38018
Practice Address - Country:US
Practice Address - Phone:901-475-5422
Practice Address - Fax:901-475-5595
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG58391208600000X
NV6635208600000X
TN41239208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002003045Medicaid
CA00G583910Medicaid
NV1174908879OtherNPI
CA00G583911Medicare PIN
NV002003045Medicaid
CACS427Medicare PIN
NVV105788Medicare PIN
NVV105675Medicare PIN
E54095Medicare UPIN
CA00G583910Medicaid