Provider Demographics
NPI:1023264876
Name:GRAY, ELEASHA R (C-FNP)
Entity type:Individual
Prefix:MS
First Name:ELEASHA
Middle Name:R
Last Name:GRAY
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 NORTH PARK TRAIL
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5086
Mailing Address - Country:US
Mailing Address - Phone:770-506-1800
Mailing Address - Fax:770-389-5947
Practice Address - Street 1:165 NORTH PARK TRAIL
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5086
Practice Address - Country:US
Practice Address - Phone:770-506-1800
Practice Address - Fax:770-389-5947
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN121625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily