Provider Demographics
NPI:1497869259
Name:GRAY, JAMES A (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MEDICAL CENTER BLVD
Mailing Address - Street 2:# G50
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2741
Mailing Address - Country:US
Mailing Address - Phone:931-438-4111
Mailing Address - Fax:866-258-0817
Practice Address - Street 1:108 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE G-50
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2741
Practice Address - Country:US
Practice Address - Phone:931-438-4111
Practice Address - Fax:866-258-0817
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL89009847OtherBCBS AL
TN3850808Medicaid
TN4015743OtherBCBS TN
TNH13568Medicare UPIN
AL89009847OtherBCBS AL
TN3850808Medicaid