Healthcare Provider Details

I. General information

NPI: 1104757749
Provider Name (Legal Business Name): PAULA GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 EASTWAY DR
CHARLOTTE NC
28205-6266
US

IV. Provider business mailing address

3709 EASTWAY DR
CHARLOTTE NC
28205-6266
US

V. Phone/Fax

Practice location:
  • Phone: 704-996-7818
  • Fax: 980-430-3075
Mailing address:
  • Phone: 704-996-7818
  • Fax: 980-430-3075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number8FTJ0MQV04
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: