Individual
DR. GREGORY L DEMOTTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
142 MEADE AVE, NICKELSVILLE, VA 24271-2108
(276) 479-2201
(276) 479-3314
Mailing address
PO BOX 3889, JOHNSON CITY, TN 37602-3889
(423) 230-2100
(423) 230-2112
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101031217
VA
207Q00000X
Family Medicine Physician
013154
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
037069
ANTHEM BLUE CROSS BLUE SH
VA
01
—
3706155
MEDICARE GROUP PIN
TN
05
—
4175553
—
TN
05
—
5609933
—
VA
Enumeration date
08/15/2006
Last updated
03/08/2021
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