Individual
MR. MARK WAYNE GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
306 AIRPORT DR, MONCKS CORNER, SC 29461-2629
(843) 761-8272
(843) 719-3025
Mailing address
306 AIRPORT DR, MONCKS CORNER, SC 29461-2629
(843) 719-3018
(843) 719-3025
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972574101
—
SC
Enumeration date
01/22/2019
Last updated
01/22/2019
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