Gray, Mark Wayne
Gray, Mark Wayne is an individual health care provider with primary practice located at 306 Airport Dr , Moncks Corner SC 29461-2629. He recently has only one registered license in Other Service Providers / Peer Specialist, which is considered as his primary health care specialty. Gray, Mark Wayne can be contacted via phone (843) 761-8272.Contact Information
Primary practice address
306 Airport Dr
Moncks Corner SC 29461-2629
Phone: (843) 761-8272
Fax: (843) 719-3025
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Peer Specialist | 175T00000X |
Profile Details
| NPI number | 1730653932 |
|---|---|
| LBN Legal business name | Gray, Mark Wayne |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 22nd, 2019 |
| Last updated | Jan 22nd, 2019 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1730653932 | NPPES |
| South Carolina | MEDICAID | 1972574101 |
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