Provider Demographics
NPI:1508430893
Name:GRAY, JENNIFER ARMACOST (AGACNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ARMACOST
Last Name:GRAY
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ARMACOST
Other - Last Name:BREWINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:755 WALTHER RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8725
Mailing Address - Country:US
Mailing Address - Phone:770-962-4895
Mailing Address - Fax:678-377-3816
Practice Address - Street 1:755 WALTHER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8725
Practice Address - Country:US
Practice Address - Phone:770-962-4895
Practice Address - Fax:678-377-3816
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA248100207RC0000X
GARN248100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease