Provider Demographics
NPI:1659587269
Name:WRAY, CHARLES HERMAN (M D)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HERMAN
Last Name:WRAY
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 RAMSGATE RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3323
Mailing Address - Country:US
Mailing Address - Phone:706-736-6056
Mailing Address - Fax:706-736-3746
Practice Address - Street 1:3115 RAMSGATE RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-3323
Practice Address - Country:US
Practice Address - Phone:706-736-6056
Practice Address - Fax:706-736-3746
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA89322086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA31453Medicare UPIN