Healthcare Provider Details

I. General information

NPI: 1134195860
Provider Name (Legal Business Name): GREGORY ALAN HINES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 S LOCUST AVE STE 102 SUITE 102
LAWRENCEBURG TN
38464-4054
US

IV. Provider business mailing address

PO BOX 926
LAWRENCEBURG TN
38464-0926
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-9416
  • Fax: 931-762-0634
Mailing address:
  • Phone: 931-762-9416
  • Fax: 931-762-0634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD37386
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: