MEDICARE: KRISTIN GREGORY PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9103077	FL
2	363A00000X	Physician Assistant	5715	GA

General Provider Information

NPI Number	:	1003925967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN GREGORY PA

Provider Business Mailing Address
First Line	:	1505 NORTHSIDE BLVD
Second Line	:	SUITE 1500
City	:	CUMMING
State	:	GA
Zip	:	30041-7623
Country	:	US
Telephone Number	:	770-781-5077
Fax Number	:	770-781-3915

Provider Business Practice Location Address
First Line	:	1505 NORTHSIDE BLVD
Second Line	:	SUITE 1500
City	:	CUMMING
State	:	GA
Zip	:	30041-7623
Country	:	US
Telephone Number	:	770-781-5077
Fax Number	:	770-781-3915

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	09/22/2015

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Directions to “ KRISTIN GREGORY PA” Practice Location

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