Provider Demographics
NPI:1275795353
Name:CLAY, RACHEL CORINNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:CORINNE
Last Name:CLAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 CEDAR SHOALS DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3509
Mailing Address - Country:US
Mailing Address - Phone:706-353-7018
Mailing Address - Fax:
Practice Address - Street 1:1805 EPPS BRIDGE PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6145
Practice Address - Country:US
Practice Address - Phone:706-549-0108
Practice Address - Fax:706-369-4047
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0545821223G0001X
GADN0149011223G0001X
390200000X
GA149011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program