Provider Demographics
NPI:1922874056
Name:ANNA C GRAY, LLC
Entity Type:Organization
Organization Name:ANNA C GRAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:440-622-3728
Mailing Address - Street 1:8224 MENTOR AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8224 MENTOR AVE STE 208
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5743
Practice Address - Country:US
Practice Address - Phone:440-622-3728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty