Provider Demographics
NPI:1144324823
Name:DOUGLAS, GREGORY LAMONT (MS)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:LAMONT
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CENTERPOINT BLVD BLDG A
Mailing Address - Street 2:SUITE 158
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1979
Mailing Address - Country:US
Mailing Address - Phone:865-374-5806
Mailing Address - Fax:865-374-9004
Practice Address - Street 1:1451 DOWELL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2441
Practice Address - Country:US
Practice Address - Phone:865-970-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2572101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional