Healthcare Provider Details

I. General information

NPI: 1568377240
Provider Name (Legal Business Name): JAMAH RAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5009 BEATTIES FORD RD STE 107-241
CHARLOTTE NC
28216-2859
US

IV. Provider business mailing address

5009 BEATTIES FORD RD STE 107-241
CHARLOTTE NC
28216-2859
US

V. Phone/Fax

Practice location:
  • Phone: 980-316-8980
  • Fax:
Mailing address:
  • Phone: 980-316-8980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: