Healthcare Provider Details

I. General information

NPI: 1114152410
Provider Name (Legal Business Name): ERNEST ROBIN GRAY III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2009
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 25TH AVE N STE 1204
NASHVILLE TN
37203-1620
US

IV. Provider business mailing address

210 25TH AVE N STE 1204
NASHVILLE TN
37203-1620
US

V. Phone/Fax

Practice location:
  • Phone: 615-312-0600
  • Fax: 615-320-3259
Mailing address:
  • Phone: 615-312-0600
  • Fax: 615-320-3259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number52111
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number52111
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: