Healthcare Provider Details

I. General information

NPI: 1174895007
Provider Name (Legal Business Name): GREGORY DENLY ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 SPRING ST NE
GAINESVILLE GA
30501-3715
US

IV. Provider business mailing address

PO BOX 2938
GAINESVILLE GA
30503-2938
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-2146
  • Fax:
Mailing address:
  • Phone: 770-536-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9334819
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: