Provider Demographics
NPI:1982793154
Name:ZENGO, GREGORY P (MD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:P
Last Name:ZENGO
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2 S MAIN ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7101
Mailing Address - Country:US
Mailing Address - Phone:706-769-5757
Mailing Address - Fax:706-769-5757
Practice Address - Street 1:2 S MAIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7101
Practice Address - Country:US
Practice Address - Phone:706-769-5757
Practice Address - Fax:706-769-5757
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA37738207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G36313Medicare UPIN
G36313Medicare UPIN