Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 042215 | GA |
NPI | 1003829433 |
---|---|
Provider Name | Dr. Dwayne Lee Clay |
First Address | Macon, GA 31210-5779 |
Second Address | Macon, GA 31210-5779 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 01/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00738493H | (05) | GA |
E76823 | (02) | GA |