Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD027356 | TN |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MD027356 | TN |
NPI | 1336109412 |
---|---|
Provider Name | Dr. Gregory L. Phelps |
First Address | Chattanooga, TN 37416-2367 |
Second Address | Chattanooga, TN 37416-2367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 07/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000579268A | (05) | GA |
0447283 | (05) | TN |
1501013 | (05) | TN |
3808658 | (05) | TN |
441504 | GROUP CCN (01) | |
B92499 | (02) | TN |