MEDICARE: MIKAELA ROSE GRAY 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	11428	GA

General Provider Information

NPI Number	:	1740989615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAELA ROSE GRAY PA

Provider Business Mailing Address
First Line	:	993 JOHNSON FY RD NE STE 210
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1620
Country	:	US
Telephone Number	:	404-256-1727
Fax Number	:	404-252-3591

Provider Business Practice Location Address
First Line	:	993 JOHNSON FY RD NE STE 210
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1620
Country	:	US
Telephone Number	:	404-256-1727
Fax Number	:	404-252-3591

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

Provider Enumeration Date	:	02/28/2023
Last Update Date	:	01/05/2026

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Directions to “ MIKAELA ROSE GRAY PA” Practice Location

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