Provider Demographics
NPI:1700376407
Name:GRAY, HARRISON M (MD)
Entity Type:Individual
Prefix:
First Name:HARRISON
Middle Name:M
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CROSSINGS CIR STE 103
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8591
Mailing Address - Country:US
Mailing Address - Phone:615-680-0110
Mailing Address - Fax:615-549-7044
Practice Address - Street 1:2525 PERIMETER PLACE DR STE 105
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3674
Practice Address - Country:US
Practice Address - Phone:615-680-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN63334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ068712Medicaid