Healthcare Provider Details

I. General information

NPI: 1154394260
Provider Name (Legal Business Name): GREGORY ALAN SEXTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 LAUREL ST
COLUMBIA SC
29201
US

IV. Provider business mailing address

1708 LAUREL ST
COLUMBIA SC
29201
US

V. Phone/Fax

Practice location:
  • Phone: 803-252-6222
  • Fax: 803-771-7724
Mailing address:
  • Phone: 803-252-6222
  • Fax: 803-771-7724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number11642
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: