Provider Demographics
NPI:1356517577
Name:GRAY, OTIS LEE JR (MD)
Entity type:Individual
Prefix:DR
First Name:OTIS
Middle Name:LEE
Last Name:GRAY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3651 WHEELER RD
Mailing Address - Street 2:DOCTORS HOSPITAL OF AUGUSTA
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6521
Mailing Address - Country:US
Mailing Address - Phone:706-651-6488
Mailing Address - Fax:706-651-2041
Practice Address - Street 1:3651 WHEELER RD
Practice Address - Street 2:DOCTORS HOSPITAL OF AUGUSTA
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6521
Practice Address - Country:US
Practice Address - Phone:706-651-6488
Practice Address - Fax:706-651-2041
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
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Provider Licenses
StateLicense IDTaxonomies
GA15858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD40007Medicare UPIN