Healthcare Provider Details

I. General information

NPI: 1114479151
Provider Name (Legal Business Name): GREGORY FLORA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 WHITAKER ROAD
BULLS GAP TN
37711
US

IV. Provider business mailing address

190 WHITAKER RD
BULLS GAP TN
37711-4919
US

V. Phone/Fax

Practice location:
  • Phone: 423-429-5490
  • Fax: 423-393-1135
Mailing address:
  • Phone: 423-429-5490
  • Fax: 423-393-1135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: