Provider Demographics
NPI:1134106925
Name:WILSON, CLAY H (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAY
Middle Name:H
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 ST. SEBASTIAN WAY
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901
Mailing Address - Country:US
Mailing Address - Phone:706-722-6900
Mailing Address - Fax:706-722-5118
Practice Address - Street 1:820 ST. SEBASTIAN WAY
Practice Address - Street 2:SUITE 8A
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-722-6900
Practice Address - Fax:706-722-5118
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043510207RN0300X
SC13568207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000749911ACMedicaid
GA000749911MMedicaid
GA338224OtherWELLCARE OF GA
GA000749911AEMedicaid
GA000749911AFMedicaid
GA000749911KMedicaid
GA000749911PMedicaid
GA000951915EMedicaid
GA10058037OtherAMERIGROUP
GA1134106925OtherBCBS-GA
SCG43510Medicaid
GA000749911AMedicaid
GA000749911ABMedicaid
GA000749911ADMedicaid
GA000749911AGMedicaid
GA000951915BMedicaid
GA000951915CMedicaid
GA000749911AHMedicaid
GA000749911AIMedicaid
GA390005010OtherRAILROAD MEDICARE
GA000951915BMedicaid
GA000749911AGMedicaid
GA000749911AMedicaid