Provider Demographics
NPI:1861044042
Name:GREGORY, BRANDON THOMAS (PA)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:THOMAS
Last Name:GREGORY
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 DILLARD CT
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-8195
Mailing Address - Country:US
Mailing Address - Phone:864-420-3270
Mailing Address - Fax:
Practice Address - Street 1:200 HERLONG AVE S STE A
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1182
Practice Address - Country:US
Practice Address - Phone:803-324-1028
Practice Address - Fax:803-328-6455
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-09245363A00000X
SC5784363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant