Basic Information
| Provider Information | |||||||||
| NPI: | 1205890399 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREGG | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | ROMAINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 743904 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303743904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035455700 | ||||||||
| FaxNumber: | 8034344699 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 MEDICAL PARK RD STE LL910 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292036808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035455700 | ||||||||
| FaxNumber: | 8034344699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 07/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207SG0201X | 27130 | SC | N | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | 207V00000X | 27130 | SC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VM0101X | 27130 | SC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 271306 | 05 | SC | MEDICAID | 003587300 | 05 | FL | MEDICAID |