Provider Demographics
NPI:1447341664
Name:BUTLER, GREGORY SCOTT (PA)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:BUTLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 WARM SPRINGS RD STE C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-5328
Mailing Address - Country:US
Mailing Address - Phone:706-653-2255
Mailing Address - Fax:706-653-2329
Practice Address - Street 1:2737 WARM SPRINGS RD STE C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5328
Practice Address - Country:US
Practice Address - Phone:706-653-2255
Practice Address - Fax:706-653-2255
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004687363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant