Provider Demographics
NPI:1841268521
Name:SZYCH, GREGORY (DO)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:SZYCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 GRANT AVE
Mailing Address - Street 2:STE G
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6165
Mailing Address - Country:US
Mailing Address - Phone:731-425-5752
Mailing Address - Fax:731-422-5743
Practice Address - Street 1:700 W FOREST AVE
Practice Address - Street 2:STE 300
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3937
Practice Address - Country:US
Practice Address - Phone:731-422-0305
Practice Address - Fax:731-422-0357
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21337207RG0100X
IL036151389207RG0100X
TNDO1484207RG0100X
GA95095207RG0100X
KY04449207RG0100X
VA0102204735207RG0100X
CODR.0043812207RG0100X
ARE8994207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04205019Medicaid
TN3307407Medicaid
KY7100407180Medicaid
TN100017319OtherRRMC