Provider Demographics
NPI:1174087860
Name:CLAXTON, GREGORY COREY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:COREY
Last Name:CLAXTON
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 N HARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS IS
Mailing Address - State:GA
Mailing Address - Zip Code:31522-5341
Mailing Address - Country:US
Mailing Address - Phone:912-634-0959
Mailing Address - Fax:912-634-1753
Practice Address - Street 1:600 COASTAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-1973
Practice Address - Country:US
Practice Address - Phone:912-554-8500
Practice Address - Fax:912-351-6309
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-26
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN254453363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty