Provider Demographics
NPI:1255863817
Name:GRAY, WILLIAM HENRY III (RN)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HENRY
Last Name:GRAY
Suffix:III
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4407 FESSENDEN ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4065
Mailing Address - Country:US
Mailing Address - Phone:804-677-6924
Mailing Address - Fax:
Practice Address - Street 1:920 VARNUM ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2145
Practice Address - Country:US
Practice Address - Phone:202-854-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001236100163WC0400X
DCRN1055366163WX0106X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health