Latasha Denise Gray, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1091538 Issued in CO

Practice address

650 North Ave NE # S204
Atlanta, GA 30308-2705

Phone

(404) 504-6554

NPI assigned

Apr 29, 2010

Last updated

Aug 2, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellstreet of Georgia PCGroup PAC ID 7517126279, 425 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Wellstreet of Georgia PC

  dba Piedmont Urgent Care

  • Urgent Care Clinic/Center
  • Newnan, GA
  • NPI 1235411547
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1272499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627862400000",
    "number": "1740507730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EMBARCADERO CTR STE 1900",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941113723",
            "telephone_number": "415-658-6791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 NORTH AVE NE # S204",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082705",
            "telephone_number": "404-504-6554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1061 HARMON AVENUE",
            "address_2": "WINN ARMY COMMUNITY HOSPITAL",
            "address_purpose": "LOCATION",
            "city": "FORT STEWART",
            "state": "GA",
            "postal_code": "313145674",
            "country_code": "US",
            "telephone_number": "912-435-6965",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAY",
        "first_name": "LATASHA",
        "middle_name": "DENISE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-29",
        "last_updated": "2021-08-02",
        "certification_date": "2021-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "1091538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jade Gray
• Katherine Gray
• Kensi N Gray
• Keshia Gray
• Kyra Adelina Gray, PA-C, MPH
• Lauren Gray, MS, BCBA
• Leah Dickie Gray, NP
• Margaux Black Gray, MD
• Matthew Robert Gray, D.M.D.
• Mikaela Rose Gray, PA

• Physician Assistant in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.