1952760704 NPI number — WILLIAM CLAYTON

Table of content: WILLIAM CLAYTON (NPI 1952760704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952760704 NPI number — WILLIAM CLAYTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLAYTON
Provider First Name:
WILLIAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952760704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1613 WALNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27511-5928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-535-8758
Provider Business Mailing Address Fax Number:
919-535-3271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
166 SPRINGBROOK AVE
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27520-8520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-535-8461
Provider Business Practice Location Address Fax Number:
919-535-8459
Provider Enumeration Date:
02/22/2016

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: 225100000X , with the licence number:  P16147 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com