Provider Demographics
NPI:1760895676
Name:GRAY, NATHANIEL GARRETT (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:GARRETT
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:PO BOX 63308
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3308
Mailing Address - Country:US
Mailing Address - Phone:866-264-3435
Mailing Address - Fax:864-987-1611
Practice Address - Street 1:1801 SUNSET DR
Practice Address - Street 2:INTERNAL MEDICINE CLINIC
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-4153
Practice Address - Fax:803-434-4160
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL36985207R00000X
SC369852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine