Provider Demographics
NPI:1235127713
Name:BLEHM, CLAYTON GREGG (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:GREGG
Last Name:BLEHM
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 1:2061 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2034
Mailing Address - Country:US
Mailing Address - Phone:770-532-4444
Mailing Address - Fax:770-535-1852
Practice Address - Street 1:2061 BEVERLY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2034
Practice Address - Country:US
Practice Address - Phone:770-532-4444
Practice Address - Fax:770-535-1852
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500892207W00000X
GA059602207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA817261230AMedicaid
NC5901302Medicaid
NC5901302Medicaid
GA817261230AMedicaid
I35941Medicare UPIN