Basic Information
| Provider Information | |||||||||
| NPI: | 1245223494 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREGG | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | CFNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 118008 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294238008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435673206 | ||||||||
| FaxNumber: | 8435676287 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 FUNK AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT STEPHEN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294793383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435673206 | ||||||||
| FaxNumber: | 8435673287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 07/06/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | F2390 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | NP0061 | 05 | SC | MEDICAID | P00928291 | 01 | SC | RR MEDICARE | OTHER |