Russell Gray, L.P.C.

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC002699 Issued in GA

Practice address

139 Renaissance Pkwy NE
Atlanta, GA 30308-2324

Phone

(404) 874-2224

Fax

(404) 874-2353

NPI assigned

Dec 16, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Rusty Gray Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/stjudesrecovery/r4/

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.

• Ascensa Health, Inc.

  • Substance Abuse Rehabilitation Facility
  • Atlanta, GA
  • NPI 1902949712
  NPD (past)

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

{
    "created_epoch": "1481846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481846400000",
    "number": "1831633452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 RENAISSANCE PKWY NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082324",
            "telephone_number": "404-874-2224",
            "fax_number": "404-874-2353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 RENAISSANCE PKWY NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082324",
            "telephone_number": "404-874-2224",
            "fax_number": "404-874-2353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "RUSSELL",
        "credential": "L.P.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-12-16",
        "last_updated": "2016-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC002699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RUSTY",
            "last_name": "GRAY",
            "credential": "L.P.C.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Margaux Black Gray, MD
• Matthew Robert Gray, D.M.D.
• Mikaela Rose Gray, PA
• Rachel Gray, PA-C
• Robert M Gray, DMD
• Sara Gray, PAA
• Linda Arnice Grays, PH.D.
• Emily Kristine Grayson, MMS PA-C
• Lasha Grayson
• Casey Graziani, MD

• Professional Counselor in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2016; 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.