Healthcare Provider Details

I. General information

NPI: 1306648894
Provider Name (Legal Business Name): TANYA GREGORY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 OLD HIGHWAY 5
BLUE RIDGE GA
30513-6248
US

IV. Provider business mailing address

1810 CARDINAL RD
MURPHY NC
28906-3274
US

V. Phone/Fax

Practice location:
  • Phone: 762-210-0515
  • Fax:
Mailing address:
  • Phone: 762-210-0515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License NumberA033637
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: