Provider Demographics
NPI:1467407908
Name:GRAY, SAMUEL BEMISS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:BEMISS
Last Name:GRAY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S MARSHALL ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2843
Mailing Address - Country:US
Mailing Address - Phone:336-276-1278
Mailing Address - Fax:336-276-1516
Practice Address - Street 1:100 S MARSHALL ST STE 1
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2843
Practice Address - Country:US
Practice Address - Phone:336-276-1278
Practice Address - Fax:336-276-1516
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3079103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046WEOtherBLUE CROSS/BLUE SHIELD ID