Healthcare Provider Details

I. General information

NPI: 1750392627
Provider Name (Legal Business Name): GRAY FAMILY HEALTHCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 GRAY COMMONS CIR
GRAY TN
37615-5407
US

IV. Provider business mailing address

203 GRAY COMMONS CIR
GRAY TN
37615-5407
US

V. Phone/Fax

Practice location:
  • Phone: 423-477-0600
  • Fax: 423-477-0611
Mailing address:
  • Phone: 423-477-0600
  • Fax: 423-477-0611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRUCE D BOGGS
Title or Position: PRESIDENT
Credential: MD
Phone: 423-477-0600