Individual
DR. GREGORY J NIECKULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1238 TAFT HIGHWAY, SUITE 170, SIGNAL MOUNTAIN, TN 37377-3295
(423) 886-2004
(423) 886-7803
Mailing address
1238 TAFT HIGHWAY, SUITE 170, SIGNAL MOUNTAIN, TN 37377-3295
(423) 886-2004
(423) 886-7803
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2524
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q005749
—
TN
Enumeration date
06/01/2011
Last updated
08/01/2014
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