Individual
MARY LEE GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D./PH.D.
Contact information
Practice address
9 RICHLAND MEDICAL PARK DR STE 110, COLUMBIA, SC 29203-6859
(803) 434-7961
(803) 758-0134
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
074718
GA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
81904
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GA1803
—
SC
Enumeration date
05/13/2008
Last updated
04/28/2021
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