Active NPI
Gregory Alan Madray, DDS PC
- Dentist
- Jesup, GA
National Provider Identifier
1366557019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10343
- Practice address
- 107 West Cherry St
Jesup, GA 31545 - Phone
- (912) 427-6404
- Fax
- (912) 427-8628
- NPI assigned
- Aug 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10343 GA | GA | |
| Dentist | 122300000X | 10343 | GA | Primary |
Addresses
Primary practice location
107 West Cherry St
Jesup, GA 31545
Mailing address
107 West Cherry St
Jesup, GA 31545
Phone (912) 427-6404
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00325619D | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10343 | GA | MD | Dentist |
| 10343 GA | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366557019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 WEST CHERRY ST",
"city": "JESUP",
"state": "GA",
"postal_code": "31545",
"telephone_number": "912-427-6404",
"fax_number": "912-427-8628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 WEST CHERRY ST",
"city": "JESUP",
"state": "GA",
"postal_code": "31545",
"telephone_number": "912-427-6404",
"fax_number": "912-427-8628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADRAY",
"first_name": "GREGORY",
"middle_name": "ALAN",
"name_prefix": "Mr.",
"credential": "DDS PC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "10343 GA",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "10343",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00325619D",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jesup, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.