Provider Demographics
NPI:1083194823
Name:GRAY, ANTHONY RAYMON
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:RAYMON
Last Name:GRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 E MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2598
Mailing Address - Country:US
Mailing Address - Phone:614-626-3648
Mailing Address - Fax:833-256-8064
Practice Address - Street 1:5310 E MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2598
Practice Address - Country:US
Practice Address - Phone:614-626-3648
Practice Address - Fax:833-256-8064
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker