Healthcare Provider Details

I. General information

NPI: 1144624883
Provider Name (Legal Business Name): JANET GRAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 HIGHWAY 119 SOUTH
SPRINGFIELD GA
31329
US

IV. Provider business mailing address

150 SCANTON CONNECTOR
BRUNSWICK GA
31525
US

V. Phone/Fax

Practice location:
  • Phone: 912-754-6484
  • Fax: 912-754-7623
Mailing address:
  • Phone: 912-262-2300
  • Fax: 912-262-2315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN234036
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: