Provider Demographics
NPI:1154862860
Name:MCCRAY, ANTHONY
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:MCCRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4193 CHESTNUT LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4578
Mailing Address - Country:US
Mailing Address - Phone:770-899-0258
Mailing Address - Fax:
Practice Address - Street 1:4193 CHESTNUT LAKE AVE
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-4578
Practice Address - Country:US
Practice Address - Phone:770-899-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician