Provider Demographics
NPI:1902204712
Name:CLAYBORNE, EBONY
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:CLAYBORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 NEW HOPE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-6409
Mailing Address - Country:US
Mailing Address - Phone:864-606-8327
Mailing Address - Fax:864-751-5909
Practice Address - Street 1:2320 E NORTH ST
Practice Address - Street 2:SUITE DD ROOM 111
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-1247
Practice Address - Country:US
Practice Address - Phone:864-606-8327
Practice Address - Fax:864-751-5909
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health