Individual provider Active NPI

James Nathan Gray, DMD

  • General Practice Dentistry
  • Fort Payne, AL
National Provider Identifier
1891280913
Registry record updated Jun 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6545 Issued in AL
Practice address
110 23Rd St NW
Fort Payne, AL 35967-3671
Phone
(256) 845-0765
Fax
(256) 845-9895
NPI assigned
Jun 30, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6545 AL Primary

Addresses

Primary practice location

110 23Rd St NW
Fort Payne, AL 35967-3671

Mailing address

PO Box 681329
Fort Payne, AL 35968-1614
Phone (256) 845-0765

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190304002516 AL Practitioner - Dentist 7113266404 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6545ALMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Wilson & Fiquett, D.M.D., P.C. General Practice CurrentSince Oct 5, 2018 Accepting new patients

Locations

110 23rd St NW
Fort Payne, AL 35967
Phone (256) 845-0765

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1530316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530316800000",
    "number": "1891280913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 681329",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359681614",
            "telephone_number": "256-845-0765",
            "fax_number": "256-845-9895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 23RD ST NW",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359673671",
            "telephone_number": "256-845-0765",
            "fax_number": "256-845-9895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "JAMES",
        "middle_name": "NATHAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-30",
        "last_updated": "2018-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "6545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Payne, AL

Sources for this page

Verify at the official NPI Registry.