MEDICARE: DR. OLIVER LEE 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	2084P0804X	Child & Adolescent Psychiatry Physician	19965	TN
2	2084P0800X	Psychiatry Physician	19965	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4025692	OTHER	TN	BLUE CROSS
2	4382001	OTHER	TN	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	E50707	OTHER	TN	UPIN

General Provider Information

NPI Number	:	1588772545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLIVER LEE GREGORY M.D.

Provider Business Mailing Address
First Line	:	7345 COURAGE WAY
Second Line	:	STE 101
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-1555
Country	:	US
Telephone Number	:	423-602-9791
Fax Number	:	423-499-2308

Provider Business Practice Location Address
First Line	:	7345 COURAGE WAY
Second Line	:	STE 101
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-1555
Country	:	US
Telephone Number	:	423-648-9290
Fax Number	:	423-499-2308

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	01/03/2019

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