Provider Demographics
NPI:1891377065
Name:GRAY, JADE
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17279 SW JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-5002
Mailing Address - Country:US
Mailing Address - Phone:503-481-5253
Mailing Address - Fax:
Practice Address - Street 1:1201 W PEACHTREE ST NW STE 2300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3453
Practice Address - Country:US
Practice Address - Phone:503-481-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula