MEDICARE: PAULA GRAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	8FTJ0MQV04	NC

General Provider Information

NPI Number	:	1104757749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA GRAY

Provider Business Mailing Address
First Line	:	3709 EASTWAY DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6266
Country	:	US
Telephone Number	:	704-996-7818
Fax Number	:	980-430-3075

Provider Business Practice Location Address
First Line	:	3709 EASTWAY DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6266
Country	:	US
Telephone Number	:	704-996-7818
Fax Number	:	980-430-3075

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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Directions to “ PAULA GRAY ” Practice Location

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