Healthcare Provider Details

I. General information

NPI: 1851229033
Provider Name (Legal Business Name): ZINA BONITA GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 EDGEWOOD PL
CLINTON MS
39056-3903
US

IV. Provider business mailing address

1611 EDGEWOOD PL
CLINTON MS
39056-3903
US

V. Phone/Fax

Practice location:
  • Phone: 601-339-6553
  • Fax: 601-339-6549
Mailing address:
  • Phone: 601-339-6553
  • Fax: 601-339-6549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberCN25223709
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: