MEDICARE: DR. GREGORY STRAYHORN MD, PHD

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	207Q00000X	Family Medicine Physician	049522	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528068194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY STRAYHORN MD, PHD

Provider Business Mailing Address
First Line	:	720 WESTVIEW DRIVE, SE
Second Line	:	HARRIS BLDG, STE 100-A
City	:	ATLANTA
State	:	GA
Zip	:	30310-1458
Country	:	US
Telephone Number	:	404-756-1400
Fax Number	:	404-756-5274

Provider Business Practice Location Address
First Line	:	1513 EAST CLEVELAND AVE
Second Line	:	BLDG. 500
City	:	EAST POINT
State	:	GA
Zip	:	30344-6947
Country	:	US
Telephone Number	:	404-752-1000
Fax Number	:	404-756-5274

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	03/31/2017

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