Healthcare Provider Details

I. General information

NPI: 1952072167
Provider Name (Legal Business Name): GREGORY ANESTHESIA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 SAINT MATTHEWS RD
ORANGEBURG SC
29118-1442
US

IV. Provider business mailing address

4202 LINKS CT
N CHARLESTON SC
29420-7574
US

V. Phone/Fax

Practice location:
  • Phone: 803-533-2200
  • Fax:
Mailing address:
  • Phone: 803-682-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON GREGORY
Title or Position: OWNER
Credential: DO
Phone: 803-682-0344