Provider Demographics
NPI:1790294700
Name:GRAY, G. ANTOINE
Entity Type:Individual
Prefix:MR
First Name:G. ANTOINE
Middle Name:
Last Name:GRAY
Suffix:
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 1:2100 PHILLIPS AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405
Mailing Address - Country:US
Mailing Address - Phone:336-965-8467
Mailing Address - Fax:
Practice Address - Street 1:2100 PHILLIPS AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405
Practice Address - Country:US
Practice Address - Phone:336-965-8467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management