Provider Demographics
NPI:1851538284
Name:GRAY, DIANE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 WASHINGTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238
Mailing Address - Country:US
Mailing Address - Phone:404-964-0298
Mailing Address - Fax:770-252-1102
Practice Address - Street 1:646 WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-8516
Practice Address - Country:US
Practice Address - Phone:404-964-0298
Practice Address - Fax:770-252-1102
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN104383163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse