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General NPI Number Information
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NPI Number | 1871726711
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Entity Type | Individual
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Provider Name | MARGO DIANE GRAY NP
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Gender | Female
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Dates
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Enumeration Date | 08/26/2009
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Last Update Date | 08/20/2020
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Provider Practice Location Address
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Address Line | 10130 PERIMETER PKWY STE 200
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City | CHARLOTTE
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State | NC
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Zip | 28216-2447
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Country | US
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Telephone | 888-849-7379
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Fax | 855-857-7333
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Provider Business Mailing Address
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Address Line | 3046 CULLENS DR
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City | GRAHAM
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State | NC
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Zip | 27253-5407
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Country | US
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Telephone | 336-214-5260
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5008662
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3006128
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License Number State | KY
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