Samuel Bemiss Gray, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3079 Issued in NC

Practice address

100 S Marshall St Ste 1
Winston Salem, NC 27101-2843

Phone

(336) 276-1278

Fax

(336) 276-1516

NPI assigned

May 23, 2006

Last updated

Apr 4, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Carolina Psychology Group, PLLC

  • Clinical Psychologist
  • Winston Salem, NC
  • NPI 1265997407
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649030400000",
    "number": "1467407908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S MARSHALL ST STE 1",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271012843",
            "telephone_number": "336-276-1278",
            "fax_number": "336-276-1516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S MARSHALL ST STE 1",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271012843",
            "telephone_number": "336-276-1278",
            "fax_number": "336-276-1516"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2910 Briarcliffe Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271063177",
            "country_code": "US",
            "telephone_number": "336-276-1278 x200",
            "fax_number": "336-276-1516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "840 W 4th St",
            "address_purpose": "LOCATION",
            "city": "Winston-Salem",
            "state": "NC",
            "postal_code": "271012502",
            "country_code": "US",
            "telephone_number": "336-773-0900 x21",
            "fax_number": "336-773-0097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAY",
        "first_name": "SAMUEL",
        "middle_name": "BEMISS",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "3079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD ID",
            "identifier": "046WE",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Lynn Graves, MD
• Gray Chiropractic and Sports Associates, P.a.
• Emma Gray
• Latonya Shari Gray, DNP, PMHNP-BC
• Lawrence Dennis Gray Jr., D.C.
• Shaketha Acquinetta Gray, M.D
• Sheila J Gray, M.A., CCC-A
• Theresa Gray, MHS PA-C
• Andrea Helen Graziano
• Kelsey E Graziose

• Clinical Psychologist in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.