MEDICARE: GREGORY NATHAN FANCHER MS

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	103TB0200X	Cognitive & Behavioral Psychologist

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	:	1578623914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY NATHAN FANCHER MS

Provider Business Mailing Address
First Line	:	1050 RIBAUT RD
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29902-5400
Country	:	US
Telephone Number	:	843-524-8899
Fax Number	:	843-524-8179

Provider Business Practice Location Address
First Line	:	603 BARNWELL HWY
Second Line	:
City	:	ALLENDALE
State	:	SC
Zip	:	29810-1905
Country	:	US
Telephone Number	:	803-584-4636
Fax Number	:	803-584-5065

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	08/20/2010

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