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General NPI Number Information
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NPI Number | 1114169299
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Entity Type | Organization
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Legal Business Name | W. WILSON GRAY JR., M.D.PHD.P.C.
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Dates
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Enumeration Date | 04/03/2009
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Last Update Date | 04/03/2009
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Provider Practice Location Address
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Address Line | 840 PINE ST SUITE 910
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City | MACON
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State | GA
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Zip | 31201-2100
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Country | US
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Telephone | 478-742-0059
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Fax | 478-746-3086
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Provider Business Mailing Address
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Address Line | 840 PINE ST SUITE 910
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City | MACON
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State | GA
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Zip | 31201-2100
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Country | US
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Telephone | 478-742-0059
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Fax | 478-746-3086
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. WOODROW WILSON GRAY JR.
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Credential | MD.,PHD.
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Telephone | 478-742-0059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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