Provider Demographics
NPI:1942313986
Name:CLAYTON, CHARLES ASHLEY (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ASHLEY
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 DONELSON PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-2926
Mailing Address - Country:US
Mailing Address - Phone:615-889-7111
Mailing Address - Fax:
Practice Address - Street 1:130 DONELSON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2926
Practice Address - Country:US
Practice Address - Phone:615-889-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 82381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
01632507OtherUNITED CONCORDIA
TN4086286OtherBCBS