Provider Demographics
NPI:1619325990
Name:GRAY, DARIN (PA)
Entity type:Individual
Prefix:
First Name:DARIN
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1806
Mailing Address - Country:US
Mailing Address - Phone:803-328-1831
Mailing Address - Fax:803-324-5131
Practice Address - Street 1:1533 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1806
Practice Address - Country:US
Practice Address - Phone:803-328-1831
Practice Address - Fax:803-324-5131
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5308363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant