Individual provider Active NPI

Garry Wayne Bray, CRNA

  • Certified Registered Nurse Anesthetist
  • Memphis, TN
National Provider Identifier
1962425926
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R567604 Issued in MS
Practice address
6025 Walnut Grove Rd
Suite 314
Memphis, TN 38120-2131
Phone
(901) 682-7665
Fax
(901) 767-8486
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R567604 MS Primary

Addresses

Primary practice location

6025 Walnut Grove Rd
Suite 314
Memphis, TN 38120-2131

Mailing address

420 Cedar Hills Rd
Holly Springs, MS 38635-7511
Phone (662) 252-5733

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040605000311 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 1658353354 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
R567604MSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Lifelinc Anesthesia, PLLC Nurse Anesthetist, Certified Registered CurrentSince Apr 1, 2022 Accepting new patients
Baptist Memorial Hospital Union County, Inc. CurrentSince Jun 1, 2018 Accepting new patients
Anesthesia Services of Memphis, PLLC Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

634 Leigh Dr
Columbus, MS 39705
Phone (601) 978-3393

200 State Highway 30 W
New Albany, MS 38652
Phone (601) 534-7631

499 Azalea Dr
Oxford, MS 38655
Phone (662) 234-7979

Organizations & group practices 3

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962425926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 CEDAR HILLS RD",
            "city": "HOLLY SPRINGS",
            "state": "MS",
            "postal_code": "386357511",
            "telephone_number": "662-252-5733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6025 WALNUT GROVE RD",
            "address_2": "SUITE 314",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202131",
            "telephone_number": "901-682-7665",
            "fax_number": "901-767-8486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAY",
        "first_name": "GARRY",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "R567604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.