Healthcare Provider Details

I. General information

NPI: 1790294700
Provider Name (Legal Business Name): MR. G. ANTOINE GRAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 PHILLIPS AVENUE SUITE B
GREENSBORO NC
27405
US

IV. Provider business mailing address

2100 PHILLIPS AVENUE SUITE B
GREENSBORO NC
27405
US

V. Phone/Fax

Practice location:
  • Phone: 336-965-8467
  • Fax:
Mailing address:
  • Phone: 336-965-8467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: