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NPI Code Detail

MEDICARE: DANIEL A GRAY PA-C

MEDICARE: DANIEL A GRAY PA-C
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
1363A00000XPhysician Assistant
2363A00000XPhysician Assistant10943GA

General Provider Information

NPI Number : 1912651985
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL A GRAY PA-C
Provider Business Mailing Address
First Line : 850 PIEDMONT AVE NE UNIT 3118
Second Line :
City : ATLANTA
State : GA
Zip : 30308-1494
Country : US
Telephone Number : 240-409-1422
Fax Number :
Provider Business Practice Location Address
First Line : 882 PONCE DE LEON AVE NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-4268
Country : US
Telephone Number : 770-809-3034
Fax Number : 404-347-9445
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2022
Last Update Date : 02/03/2025

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