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NPI Code Detail

MEDICARE: KESHIA GRAY

MEDICARE: KESHIA 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1194368233
Entity Type Code : Individual
Provider Name (Legal Business Name) : KESHIA GRAY
Provider Business Mailing Address
First Line : 858 LORRIMONT LN
Second Line :
City : FAIRBURN
State : GA
Zip : 30213-4833
Country : US
Telephone Number : 407-221-2483
Fax Number :
Provider Business Practice Location Address
First Line : 1373 CLEVELAND AVE
Second Line :
City : ATLANTA
State : GA
Zip : 30344-3423
Country : US
Telephone Number : 678-573-2970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2019
Last Update Date : 10/22/2019

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Directions to “ KESHIA GRAY ” Practice Location

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