Provider Demographics
NPI:1265463277
Name:CLAYTON HEALTHCARE, P.C.
Entity Type:Organization
Organization Name:CLAYTON HEALTHCARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-478-7828
Mailing Address - Street 1:3139 BAY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-4139
Mailing Address - Country:US
Mailing Address - Phone:770-478-7828
Mailing Address - Fax:770-478-9010
Practice Address - Street 1:3139 BAY VIEW DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-4139
Practice Address - Country:US
Practice Address - Phone:404-695-3989
Practice Address - Fax:770-991-5012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035982207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA085002918GMedicaid
GA085002918GMedicaid
CG9126Medicare ID - Type UnspecifiedRAILROAD MEDICARE