Basic Information
| Provider Information | |||||||||
| NPI: | 1679580294 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | NEAL | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 356 24TH AVE N | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152925722 | ||||||||
| FaxNumber: | 6153466225 | ||||||||
| Practice Location | |||||||||
| Address1: | 3443 DICKERSON PIKE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372072519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158650700 | ||||||||
| FaxNumber: | 6158655534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 09/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 28445 | TN | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 38027551 | 05 | TN | MEDICAID |