Provider Demographics
NPI:1457467219
Name:BRAY, JOEL SCOTT
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:SCOTT
Last Name:BRAY
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 1:549 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-5721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 3RD ST N
Practice Address - Street 2:
Practice Address - City:SOPERTON
Practice Address - State:GA
Practice Address - Zip Code:30457-1160
Practice Address - Country:US
Practice Address - Phone:912-529-4774
Practice Address - Fax:912-529-4409
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine