Provider Demographics
NPI:1699928861
Name:MCCRAY, MARY SUSAN RAGAN
Entity type:Individual
Prefix:MRS
First Name:MARY SUSAN
Middle Name:RAGAN
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:SUSAN
Other - Last Name:MCCRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:18809 HAMMOCK LN
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-8835
Mailing Address - Country:US
Mailing Address - Phone:704-661-5386
Mailing Address - Fax:
Practice Address - Street 1:18809 HAMMOCK LN
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-8835
Practice Address - Country:US
Practice Address - Phone:704-661-5386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001668133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered