Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 067365 | GA |
Y | 111NI0900X | Internist | 067365 | GA |
NPI | 1003026238 |
---|---|
Provider Name | Dr. Wendy Elizabeth Gray |
First Address | Sandy Springs, GA 30328-1241 |
Second Address | Sandy Springs, GA 30328-1241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 04/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
067365 | LICENSE (01) | GA |
FG3139145 | DEA (01) | GA |
XG3139145 | DEA (01) | GA |