Provider Demographics
NPI:1811286297
Name:ANDERSON, GRETCHEN NICOLE (DO)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:NICOLE
Last Name:ANDERSON
Suffix:
Gender:
Credentials:DO
Other - Prefix:DR
Other - First Name:GRETCHEN
Other - Middle Name:NICOLE
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:500 W 3RD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1900
Mailing Address - Country:US
Mailing Address - Phone:229-312-5800
Mailing Address - Fax:
Practice Address - Street 1:3825 MEDICAL PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6831
Practice Address - Country:US
Practice Address - Phone:470-267-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018961207R00000X
OH34.015547207RG0100X
GA075910207RG0100X
GA76269207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315046810OtherCONTROLLE SUBSTANCE LICENSE