Provider Demographics
NPI:1972703056
Name:WILLIAMS GRAY, AKEMIE EDNA (MD)
Entity Type:Individual
Prefix:DR
First Name:AKEMIE
Middle Name:EDNA
Last Name:WILLIAMS GRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AKEMIE
Other - Middle Name:EDNA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N 8TH ST STE 232
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62201-2989
Mailing Address - Country:US
Mailing Address - Phone:618-337-2597
Mailing Address - Fax:618-337-2930
Practice Address - Street 1:100 N 8TH ST STE 232
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62201-2989
Practice Address - Country:US
Practice Address - Phone:618-337-2597
Practice Address - Fax:618-337-2930
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60107061208000000X
IL036131750208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8552374Medicaid