1477539252 NPI number — DR. SHARMANE MARIE GRAY MD

Table of content: DR. SHARMANE MARIE GRAY MD (NPI 1477539252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477539252 NPI number — DR. SHARMANE MARIE GRAY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAY
Provider First Name:
SHARMANE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477539252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1572 GA 85
Provider Second Line Business Mailing Address:
STE 209
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30214-1998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-402-9409
Provider Business Mailing Address Fax Number:
470-558-2898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1572 GA 85
Provider Second Line Business Practice Location Address:
STE 209
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30214-1998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-402-9409
Provider Business Practice Location Address Fax Number:
470-558-2898
Provider Enumeration Date:
12/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  C132774 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 12913 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 01054888A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 84917 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00867873 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




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