Provider Demographics
NPI:1568444305
Name:GRAY, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
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 1:6491 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30360-2100
Mailing Address - Country:US
Mailing Address - Phone:770-689-1858
Mailing Address - Fax:
Practice Address - Street 1:6491 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30360-2100
Practice Address - Country:US
Practice Address - Phone:770-689-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL256722086S0122X
NY2822822086S0122X
MS234052086S0122X
GA873552086S0122X
MO20170019682086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08176712Medicaid
AL51519686Medicaid
MS367605YKFFMedicare PIN
MS08176712Medicaid
AL51519686Medicaid
MOMA2082600Medicare PIN