1104674399 NPI number — MR. GREGORY FORREST AYERS RN

Table of content: JENNY MARCELIN (NPI 1952789356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104674399 NPI number — MR. GREGORY FORREST AYERS RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYERS
Provider First Name:
GREGORY
Provider Middle Name:
FORREST
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104674399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 UNIVERSITY PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIKEN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29801-6302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-641-5100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIT 45011
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMP ZAMA
Provider Business Practice Location Address State Name:
APO, AP
Provider Business Practice Location Address Postal Code:
96343
Provider Business Practice Location Address Country Code:
JP
Provider Business Practice Location Address Telephone Number:
315-263-5424
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
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Provider Taxonomy Codes

  • Taxonomy code: 163WE0003X , with the licence number:  243657 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)