Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 5419 | KY |
Y | 213EG0000X | General Practice | 5419 | KY |
NPI | 1003937442 |
---|---|
Provider Name | Dr. Greg Cole Nunnally |
First Address | Louisville, KY 40207-4824 |
Second Address | Louisville, KY 40207-4824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 07/12/2016 |