MEDICARE: JAMES DOUGLASS 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	311ZA0620X	Adult Care Home Facility	RN.196388	OH

General Provider Information

NPI Number	:	1497109573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES DOUGLASS GRAY

Provider Business Mailing Address
First Line	:	1530 FRANKLIN AVE
Second Line	:	NONE
City	:	CINCINNATI
State	:	OH
Zip	:	45237-5910
Country	:	US
Telephone Number	:	513-242-2164
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 FRANKLIN AVE
Second Line	:	NONE
City	:	CINCINNATI
State	:	OH
Zip	:	45237-5910
Country	:	US
Telephone Number	:	513-242-2164
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	MR. JAMES DOUGLASS GRAY
Credential	:	RN
Telephone Number	:	513-242-2164

Provider Enumeration Date	:	04/14/2016
Last Update Date	:	04/14/2016

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