Provider Demographics
NPI:1992795785
Name:HILL, EDWARD GRAY JR (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:GRAY
Last Name:HILL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1605 WESTBROOK PLAZA DR STE 302
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2900
Mailing Address - Country:US
Mailing Address - Phone:336-760-3007
Mailing Address - Fax:336-760-9334
Practice Address - Street 1:1605 WESTBROOK PLAZA DR STE 302
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2900
Practice Address - Country:US
Practice Address - Phone:336-760-3007
Practice Address - Fax:336-760-9334
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26263103TH0004X, 2084D0003X, 2084N0008X, 2084N0400X, 2084N0402X, 2084N0600X, 2084P0005X, 2084S0012X, 2084V0102X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic Neuroimaging
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC26263OtherLICENSE
NC8911609Medicaid
NC8911609Medicaid
NCC84505Medicare UPIN
NC130025654Medicare PIN