Provider Demographics
NPI:1437590304
Name:GRAY, CHALON (RNC-OB)
Entity Type:Individual
Prefix:
First Name:CHALON
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:RNC-OB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-8397
Mailing Address - Country:US
Mailing Address - Phone:678-425-5306
Mailing Address - Fax:
Practice Address - Street 1:33 LIGHTHOUSE DR
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-8397
Practice Address - Country:US
Practice Address - Phone:678-425-5306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN211347163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse