Provider Demographics
NPI:1912651985
Name:GRAY, DANIEL A (PA-C)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:GRAY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:850 PIEDMONT AVE NE UNIT 3118
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1494
Mailing Address - Country:US
Mailing Address - Phone:240-409-1422
Mailing Address - Fax:
Practice Address - Street 1:882 PONCE DE LEON AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-4268
Practice Address - Country:US
Practice Address - Phone:770-809-3034
Practice Address - Fax:404-347-9445
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
GA10943363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant