Provider Demographics
NPI:1003829433
Name:CLAY, DWAYNE LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:LEE
Last Name:CLAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6010 LAKESIDE COMMONS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5779
Mailing Address - Country:US
Mailing Address - Phone:478-475-9220
Mailing Address - Fax:478-475-9201
Practice Address - Street 1:6010 LAKESIDE COMMONS DR
Practice Address - Street 2:SUITE A
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5779
Practice Address - Country:US
Practice Address - Phone:478-475-9220
Practice Address - Fax:478-475-9201
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2009-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA042215208100000X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00738493HMedicaid
GA25BDBQZMedicare PIN
GAE76823Medicare UPIN