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Individual

GEORGE VERNON PEGRAM III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
304 WRIGHT ST, SWEETWATER, TN 37874-1181
(865) 213-8401
(865) 213-8596
Mailing address
304 WRIGHT ST, SWEETWATER, TN 37874-1181
(865) 213-8401
(865) 213-8596

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
21971
AL
207V00000X
Obstetrics & Gynecology Physician
Primary
MD55106
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009918220
AL
01
51046869
BLUE CROSS BLUE SHIELD
AL
01
6087267
BLUE CROSS BLUE SHIELD
TN
05
Q026242
TN
Enumeration date
08/17/2006
Last updated
06/22/2018
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