Provider Demographics
NPI:1306085014
Name:LAURENCE, GREGORY NATHAN (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:NATHAN
Last Name:LAURENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7485 POPLAR PIKE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-5934
Mailing Address - Country:US
Mailing Address - Phone:901-752-4999
Mailing Address - Fax:901-752-3761
Practice Address - Street 1:7485 POPLAR PIKE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-5934
Practice Address - Country:US
Practice Address - Phone:901-752-4999
Practice Address - Fax:901-752-3761
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine