Individual
CAROLYN GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5670 PEACHTREE DUNWOODY RD, SUITE 1000, ATLANTA, GA 30342-1699
(404) 255-1930
(404) 459-8510
Mailing address
5670 PEACHTREE DUNWOODY RD, SUITE 1000, ATLANTA, GA 30342-1699
(404) 255-1930
(404) 459-8510
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3456
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002586A
—
GA
01
—
10033127
AMERIGROUP
GA
01
—
1153780002
PEACHSTATE
GA
01
—
319977
WELLCARE
GA
01
—
970014443
RAILROAD MEDICARE
GA
Enumeration date
08/30/2006
Last updated
11/04/2016
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