Provider Demographics
NPI:1528570553
Name:CLAYTON, JUSTIN GRAY
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:GRAY
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 SELWYN FARMS LN APT 1
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-5005
Mailing Address - Country:US
Mailing Address - Phone:336-345-2281
Mailing Address - Fax:
Practice Address - Street 1:3308 SELWYN FARMS LN APT 1
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-5005
Practice Address - Country:US
Practice Address - Phone:336-345-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC119934367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered