MEDICARE: ANDREW MICHAEL BRAY PA

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	363A00000X	Physician Assistant	PA9106728	FL
2	363A00000X	Physician Assistant	12020	GA

General Provider Information

NPI Number	:	1245584978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW MICHAEL BRAY PA

Provider Business Mailing Address
First Line	:	220 26TH ST NW APT 5402
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1926
Country	:	US
Telephone Number	:	904-327-7543
Fax Number	:

Provider Business Practice Location Address
First Line	:	6660 ROSWELL RD
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-3167
Country	:	US
Telephone Number	:	404-996-0195
Fax Number	:	404-531-0967

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

Provider Enumeration Date	:	11/02/2012
Last Update Date	:	01/24/2024

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