Provider Demographics
NPI:1093177107
Name:GRAY, BRANDON E (MD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:E
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1125 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-1908
Mailing Address - Country:US
Mailing Address - Phone:479-713-8000
Mailing Address - Fax:479-444-7820
Practice Address - Street 1:3855 PLEASANT HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8030
Practice Address - Country:US
Practice Address - Phone:678-312-7800
Practice Address - Fax:678-312-7818
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
GA83280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program