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General NPI Number Information
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NPI Number | 1861044042
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Entity Type | Individual
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Provider Name | BRANDON THOMAS GREGORY PA
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Gender | Male
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Dates
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Enumeration Date | 07/09/2019
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 200 HERLONG AVE S STE A
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City | ROCK HILL
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State | SC
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Zip | 29732-1182
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Country | US
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Telephone | 803-324-1028
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Fax | 803-328-6455
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Provider Business Mailing Address
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Address Line | 104 DILLARD CT
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City | EASLEY
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State | SC
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Zip | 29642-8195
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Country | US
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Telephone | 864-420-3270
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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 | 0010-09245
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5784
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License Number State | SC
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