Provider Demographics
NPI:1568893782
Name:KING, CLAYTON JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:JAMES
Last Name:KING
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 HOSPITAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-1649
Mailing Address - Country:US
Mailing Address - Phone:731-352-7907
Mailing Address - Fax:731-352-4459
Practice Address - Street 1:105 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:GLEASON
Practice Address - State:TN
Practice Address - Zip Code:38229-7264
Practice Address - Country:US
Practice Address - Phone:731-648-5634
Practice Address - Fax:731-352-4459
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN2450363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3301090Medicaid
TN3380640OtherGROUP MEDICADI
TNQ003304Medicaid
TN3380640OtherGROUP MEDICARE