Most Relevant Information
Provider Data
| NPI Number: | 1003575242 |
| Provider Name: | SHAHETAH GRAY |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/15/2021 |
| Last Updated: | 12/15/2021 |
Provider Practice Location
940 GA HIGHWAY 96 STE A
WARNER ROBINS
GA
310882587
Practice Location Phone/Fax
| Phone: | 2298175454 |
| Fax: |
Provider Mailing Location
PO BOX 1311
BYRON
GA
310081311
Provider Mailing Phone/Fax
| Phone: | 4782258060 |
| Fax: |