Provider Demographics
NPI:1780686105
Name:GRAY, DONNA ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:ELIZABETH
Last Name:GRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DONNA
Other - Middle Name:ELIZABETH
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0908
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:2817 ROCK MERRIT AVE WOMACK ARMY MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-9692
Practice Address - Country:US
Practice Address - Phone:910-907-4673
Practice Address - Fax:910-907-4673
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201252208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132PPMedicaid