Provider Demographics
NPI:1053344853
Name:PYNE, GREGORY MAX (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:MAX
Last Name:PYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 879
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-0879
Mailing Address - Country:US
Mailing Address - Phone:478-289-1349
Mailing Address - Fax:478-289-1300
Practice Address - Street 1:117 KITE RD
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3231
Practice Address - Country:US
Practice Address - Phone:478-289-1349
Practice Address - Fax:478-289-1300
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA058105207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine