Provider Demographics
NPI:1841617669
Name:GRAY, MALLOREE (CPM)
Entity Type:Individual
Prefix:MRS
First Name:MALLOREE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 WIMBERLY ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2254
Mailing Address - Country:US
Mailing Address - Phone:404-895-5732
Mailing Address - Fax:
Practice Address - Street 1:1726 CHADWICK CT
Practice Address - Street 2:SUITE 200
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3318
Practice Address - Country:US
Practice Address - Phone:404-895-5732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program