MEDICARE: DR. JAMES GREGORY M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0011347	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00045619H	OTHER	GA	DSPS

General Provider Information

NPI Number	:	1336218379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES GREGORY M. D.

Provider Business Mailing Address
First Line	:	606 MOUNT SINAI RD
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-3749
Country	:	US
Telephone Number	:	706-278-9329
Fax Number	:	706-281-2395

Provider Business Practice Location Address
First Line	:	606 MOUNT SINAI RD
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-3749
Country	:	US
Telephone Number	:	706-278-9329
Fax Number	:	706-281-2395

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/09/2007

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