Provider Demographics
NPI:1194758854
Name:GREGG, KATHARINE T (MD)
Entity type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:T
Last Name:GREGG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:DIVISION OF GERIATRICS
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5610
Mailing Address - Fax:601-984-5783
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:DEPARTMENT OF MEDICINE/DIVISION OF GERIATRICS
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5610
Practice Address - Fax:601-984-6439
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2014-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS14404207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1462128Medicaid
MS0119787Medicaid
MS512I110044Medicare PIN
LA1462128Medicaid