Provider Demographics
NPI:1235592577
Name:GRAY, MARGAUX BLACK (MD)
Entity Type:Individual
Prefix:
First Name:MARGAUX
Middle Name:BLACK
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 1:5883 GLENRIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5694
Mailing Address - Country:US
Mailing Address - Phone:404-303-1314
Mailing Address - Fax:
Practice Address - Street 1:5883 GLENRIDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5694
Practice Address - Country:US
Practice Address - Phone:404-303-1314
Practice Address - Fax:404-303-1399
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA94984208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics