Provider Demographics
NPI:1710427406
Name:GRAY, GEORGE II
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:GRAY
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 KATINKA DR.
Mailing Address - Street 2:
Mailing Address - City:KALKASKA
Mailing Address - State:MI
Mailing Address - Zip Code:49646
Mailing Address - Country:US
Mailing Address - Phone:231-313-0765
Mailing Address - Fax:
Practice Address - Street 1:878 KATINKA DR NE
Practice Address - Street 2:
Practice Address - City:KALKASKA
Practice Address - State:MI
Practice Address - Zip Code:49646-9707
Practice Address - Country:US
Practice Address - Phone:231-313-0765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician