Healthcare Provider Details

I. General information

NPI: 1316184211
Provider Name (Legal Business Name): RACHEL GRAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 N DRUID HILLS RD NE
ATLANTA GA
30329-3117
US

IV. Provider business mailing address

5461 MERIDIAN MARK RD STE 400
ATLANTA GA
30342-3283
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-1200
  • Fax: 404-785-3600
Mailing address:
  • Phone: 404-785-1112
  • Fax: 404-785-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8337
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: