Provider Demographics
NPI:1598712135
Name:OVERTON, CLAYTON JUSTUS III (MD, MPH, MSPH, FAEEM)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:JUSTUS
Last Name:OVERTON
Suffix:III
Gender:M
Credentials:MD, MPH, MSPH, FAEEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1770
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70434-1770
Mailing Address - Country:US
Mailing Address - Phone:985-893-5767
Mailing Address - Fax:
Practice Address - Street 1:23 CLAUDIA DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70435-9513
Practice Address - Country:US
Practice Address - Phone:985-893-5767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35848207P00000X
MS17549207P00000X
CAA96078207P00000X
LA24366207P00000X
HI13765207P00000X
FLME119281207P00000X
KS04-37095207P00000X
WA60175689207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3870437Medicaid
CA00A960780OtherMEDI-CAL
MS00126235Medicaid
CAAT631YMedicare PIN
TN3870437Medicare ID - Type Unspecified
MS00126235Medicaid
TNP00233696Medicare ID - Type UnspecifiedMEDICARE RAILROAD
MS930003211Medicare ID - Type Unspecified