Provider Demographics
NPI:1134133465
Name:CLAYTON MEDICAL ASSOCIATES P A
Entity Type:Organization
Organization Name:CLAYTON MEDICAL ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:919-553-3900
Mailing Address - Street 1:100 GUY RD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-7206
Mailing Address - Country:US
Mailing Address - Phone:919-553-3900
Mailing Address - Fax:919-553-0395
Practice Address - Street 1:100 GUY RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-7206
Practice Address - Country:US
Practice Address - Phone:919-553-3900
Practice Address - Fax:919-553-0395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890126CMedicaid
NC890126CMedicaid
NCD33066Medicare UPIN