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General NPI Number Information
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NPI Number | 1851353577
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Entity Type | Individual
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Provider Name | GREGORY JAMES MONK PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 110 NAVAL NUCLEAR POWER TRAINING COMMAND CIR
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City | GOOSE CREEK
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State | SC
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Zip | 29445
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Country | US
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Telephone | 760-792-9073
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Fax |
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Provider Business Mailing Address
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Address Line | 246 GREAT LAWN DR
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City | SUMMERVILLE
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State | SC
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Zip | 29486-8258
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Country | US
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Telephone | 760-792-9073
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1060858
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License Number State | SC
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