Provider Demographics
NPI:1699744474
Name:GREGG, CHARLES ELI (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ELI
Last Name:GREGG
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:PO BOX 465687
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30042-5687
Mailing Address - Country:US
Mailing Address - Phone:770-237-1089
Mailing Address - Fax:
Practice Address - Street 1:1727 W NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-8114
Practice Address - Country:US
Practice Address - Phone:919-736-7908
Practice Address - Fax:770-237-1124
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19346207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-36864Medicaid
NC36864OtherBCBS OF NC
NC050077788Medicare PIN
NC89-36864Medicaid
NC2282125Medicare PIN