Provider Demographics
NPI:1740222777
Name:CLAYTON, GEORGE H (DDS, FACP)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:H
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:DDS, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 OLD HICKORY BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4223
Mailing Address - Country:US
Mailing Address - Phone:615-690-5400
Mailing Address - Fax:615-690-5404
Practice Address - Street 1:1177 OLD HICKORY BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4223
Practice Address - Country:US
Practice Address - Phone:615-690-5400
Practice Address - Fax:615-690-5404
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000048471223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN975008OtherUNITED CONCORDIA ID NUMBE
TN3094291OtherBCBS PROVIDER ID NUMBER
TN3094291OtherBCBS PROVIDER ID NUMBER