Individual
ROB GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
50 KELLY RD, MCDONOUGH, GA 30253-6012
(770) 957-1887
(770) 957-6864
Mailing address
50 KELLY RD, MCDONOUGH, GA 30253-6012
(770) 957-1887
(770) 957-6864
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3460
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10033126
AMERIGROUP
GA
01
—
1153770002
PEACHSTATE
GA
01
—
319993
WELLCARE
GA
Enumeration date
08/30/2006
Last updated
04/09/2008
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