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General NPI Number Information
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NPI Number | 1073574083
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Entity Type | Individual
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Provider Name | JIMMY LEE GREGORY DPM
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 495 WINN WAY STE 100
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City | DECATUR
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State | GA
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Zip | 30030-1709
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Country | US
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Telephone | 404-284-7744
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Fax | 404-284-8006
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Provider Business Mailing Address
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Address Line | 2140 CALVERTON LANE
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City | ATLANTA
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State | GA
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Zip | 30331-1210
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Country | US
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Telephone | 404-284-7744
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Fax | 404-284-8006
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD00598
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD000598
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License Number State | GA
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