Provider Demographics
NPI:1528068194
Name:STRAYHORN, GREGORY (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:STRAYHORN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:GREGORY
Other - Middle Name:
Other - Last Name:STRAYHORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:720 WESTVIEW DRIVE, SE
Mailing Address - Street 2:HARRIS BLDG, STE 100-A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1458
Mailing Address - Country:US
Mailing Address - Phone:404-756-1400
Mailing Address - Fax:404-756-5274
Practice Address - Street 1:1513 EAST CLEVELAND AVE
Practice Address - Street 2:BLDG. 500
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6947
Practice Address - Country:US
Practice Address - Phone:404-752-1000
Practice Address - Fax:404-756-5274
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049522207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000894088BMedicaid
08BBCBTMedicare ID - Type Unspecified
GA000894088BMedicaid