MEDICARE: CARMEN GRAY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	390200000X	Student in an Organized Health Care Education/Training Program
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1528326196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN GRAY

Provider Business Mailing Address
First Line	:	3340 POPLAR AVE STE 205
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38111-4680
Country	:	US
Telephone Number	:	901-513-7084
Fax Number	:

Provider Business Practice Location Address
First Line	:	3340 POPLAR AVE STE 205
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38111-4680
Country	:	US
Telephone Number	:	901-513-7084
Fax Number	:

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

Provider Enumeration Date	:	05/02/2012
Last Update Date	:	01/18/2022

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Directions to “ CARMEN GRAY ” Practice Location

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