Provider Demographics
NPI:1689180200
Name:CLAYTOR CLINIC, INC.
Entity Type:Organization
Organization Name:CLAYTOR CLINIC, INC.
Other - Org Name:CLAYTOR MEMORIAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLAYTOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:540-483-0373
Mailing Address - Street 1:1625 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-6390
Mailing Address - Country:US
Mailing Address - Phone:540-483-0373
Mailing Address - Fax:
Practice Address - Street 1:1625 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-6390
Practice Address - Country:US
Practice Address - Phone:540-483-0373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty