Provider Demographics
NPI:1952347999
Name:GRAY, NATHAN A (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:A
Last Name:GRAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:11808 KINGSTON PIKE STE 160
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3838
Practice Address - Country:US
Practice Address - Phone:865-966-3940
Practice Address - Fax:865-966-6914
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36905207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00225134OtherRR MEDICARE PIN
TN3882745Medicaid
TNP00225134OtherRR MEDICARE PIN
TN3714824Medicare ID - Type UnspecifiedLEGACY GROUP
TN3882745Medicare ID - Type UnspecifiedLEGACY PIN