1518918333 NPI number — DR. PAMELA RENE CLAY MD

Table of content: DR. PAMELA RENE CLAY MD (NPI 1518918333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518918333 NPI number — DR. PAMELA RENE CLAY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLAY
Provider First Name:
PAMELA
Provider Middle Name:
RENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TURNER
Provider Other First Name:
PAMELA
Provider Other Middle Name:
RENE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518918333
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3495 PIEDMONT ROAD, NE
Provider Second Line Business Mailing Address:
NINE PIEDMONT CENTER
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-364-7070
Provider Business Mailing Address Fax Number:
404-691-6959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3650 STEVE REYNOLDS BLVD.
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE GWINNETT MEDICAL CENTER
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-931-6010
Provider Business Practice Location Address Fax Number:
404-691-6959
Provider Enumeration Date:
05/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  057447 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 441147300A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".