Active NPI
Rob Gray, PA-C
- Physician Assistant
- McDonough, GA
National Provider Identifier
1790895340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 3460
- Practice address
- 50 Kelly Rd
McDonough, GA 30253-6012 - Phone
- (770) 957-1887
- Fax
- (770) 957-6864
- NPI assigned
- Aug 30, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 3460 | GA | Primary |
Addresses
Primary practice location
50 Kelly Rd
McDonough, GA 30253-6012
Mailing address
50 Kelly Rd
McDonough, GA 30253-6012
Phone (770) 957-1887
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10033126 | Other | GA | AMERIGROUP |
| 1153770002 | Other | GA | PEACHSTATE |
| 319993 | Other | GA | WELLCARE |
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
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aylo Health, LLC | Past | Accepting new patients | |
| Aylo Health, LLC | Past | Accepting new patients | |
| Aylo Health, LLC | Past | Accepting new patients | |
| Aylo Health, LLC | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Atlanta, GA
- NPI 1013018811
-
- Family Medicine Physician
- Ellenwood, GA
- NPI 1447290218
-
- Family Medicine Physician
- Locust Grove, GA
- NPI 1710929914
-
- Sleep Medicine (Family Medicine) Physician
- Stockbridge, GA
- NPI 1922831445
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207699200000",
"number": "1790895340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 KELLY RD",
"city": "MCDONOUGH",
"state": "GA",
"postal_code": "302536012",
"telephone_number": "770-957-1887",
"fax_number": "770-957-6864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 KELLY RD",
"city": "MCDONOUGH",
"state": "GA",
"postal_code": "302536012",
"telephone_number": "770-957-1887",
"fax_number": "770-957-6864"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "ROB",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2008-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "3460",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP",
"identifier": "10033126",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEACHSTATE",
"identifier": "1153770002",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "319993",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in McDonough, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.