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General NPI Number Information
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NPI Number | 1306504089
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Entity Type | Individual
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Provider Name | JAMEON KOVON GRAY
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Gender | Male
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 1035 4TH ST NW APT 902
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City | WASHINGTON
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State | DC
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Zip | 20001-3589
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Country | US
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Telephone | 301-213-7964
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Fax |
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Provider Business Mailing Address
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Address Line | 4216 BENNING RD NE APT 203
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City | WASHINGTON
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State | DC
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Zip | 20019-4546
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Country | US
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Telephone | 202-749-2277
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State | DC
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