Provider Demographics
NPI:1194232900
Name:GRAY, NEKEIA
Entity type:Individual
Prefix:
First Name:NEKEIA
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 PRESTMOOR CT
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-1575
Mailing Address - Country:US
Mailing Address - Phone:404-863-8267
Mailing Address - Fax:
Practice Address - Street 1:107 PRESTMOOR CT
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-1575
Practice Address - Country:US
Practice Address - Phone:404-863-8267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide