Provider Demographics
NPI:1316286115
Name:GRAY, BRANDON S (COHC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:S
Last Name:GRAY
Suffix:
Gender:M
Credentials:COHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 S BECKFORD DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-3486
Mailing Address - Country:US
Mailing Address - Phone:252-430-7744
Mailing Address - Fax:252-430-0917
Practice Address - Street 1:857 S BECKFORD DR
Practice Address - Street 2:SUITE H
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-3486
Practice Address - Country:US
Practice Address - Phone:252-430-7744
Practice Address - Fax:252-430-0917
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC478661247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC478661OtherCERTIFIED OCCUPATIONAL HEARING CONSERVATIONIST