Basic Information
| Provider Information | |||||||||
| NPI: | 1760895676 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAY | ||||||||
| FirstName: | NATHANIEL | ||||||||
| MiddleName: | GARRETT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 63308 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282633308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662643435 | ||||||||
| FaxNumber: | 8649871611 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 SUNSET DR | ||||||||
| Address2: | INTERNAL MEDICINE CLINIC | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034344153 | ||||||||
| FaxNumber: | 8034344160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2014 | ||||||||
| LastUpdateDate: | 04/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | LL36985 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 2085R0202X | 36985 | SC | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.