Provider Demographics
NPI:1659493724
Name:GRAY, EARNESTINE B (RN)
Entity Type:Individual
Prefix:MRS
First Name:EARNESTINE
Middle Name:B
Last Name:GRAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WARREN ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-2201
Mailing Address - Country:US
Mailing Address - Phone:404-370-7474
Mailing Address - Fax:404-370-7475
Practice Address - Street 1:23 WARREN ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-2201
Practice Address - Country:US
Practice Address - Phone:404-370-7474
Practice Address - Fax:404-370-7475
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN044329163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health