Provider Demographics
NPI:1114965936
Name:GRAY, CHRISTINE K (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:K
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17124 HIGHWAY 72 W
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:SC
Mailing Address - Zip Code:29384-5144
Mailing Address - Country:US
Mailing Address - Phone:864-393-1020
Mailing Address - Fax:864-568-3807
Practice Address - Street 1:17124 HIGHWAY 72 W
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:SC
Practice Address - Zip Code:29384-5144
Practice Address - Country:US
Practice Address - Phone:864-393-1020
Practice Address - Fax:864-568-3807
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS149522080A0000X
SC823202080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121295Medicaid
SC823201Medicaid