Organization
CLARKESVILLE DERMATOLOGY & MEDICAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER B GRAY PA (PHYSICIAN ASSISTANT)
(706) 754-5991
Entity
Organization
Contact information
Practice address
5330 HIGHWAY 115, CLARKESVILLE, GA 30523-6730
(706) 754-5991
(706) 754-6736
Mailing address
5330 HIGHWAY 115, CLARKESVILLE, GA 30523-6730
(706) 754-5991
(706) 754-6736
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
Other
Enumeration date
11/04/2016
Last updated
09/15/2018
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