Individual
MR. GREGORY WAYNE HALTOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSA
Contact information
Practice address
509 RYAN AVE, GALLATIN, TN 37066-6621
(615) 230-1714
Mailing address
509 RYAN AVE, GALLATIN, TN 37066-6621
(615) 230-1714
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
SA00211
TX
Other
Enumeration date
06/02/2010
Last updated
07/04/2011
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