Provider Demographics
NPI:1841750536
Name:HARRIS, CLAYTON ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:ANDREW
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Mailing Address - Street 2:650 JOEL DRIVE
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-0001
Mailing Address - Country:US
Mailing Address - Phone:256-338-9118
Mailing Address - Fax:253-968-0614
Practice Address - Street 1:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:650 JOEL DRIVE
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-0001
Practice Address - Country:US
Practice Address - Phone:256-338-9118
Practice Address - Fax:253-968-0614
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI73949208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice