Provider Demographics
NPI:1457327181
Name:CLAY, KELLY ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANNE
Last Name:CLAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6320 THE BLARNEY STONE
Mailing Address - Street 2:
Mailing Address - City:RAVENEL
Mailing Address - State:SC
Mailing Address - Zip Code:29470-5240
Mailing Address - Country:US
Mailing Address - Phone:843-889-1647
Mailing Address - Fax:
Practice Address - Street 1:2125 CHARLIE HALL BLVD
Practice Address - Street 2:SUITE - 2B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5879
Practice Address - Country:US
Practice Address - Phone:843-852-3151
Practice Address - Fax:843-573-1537
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC215001Medicaid
SC215001Medicaid