Provider Demographics
NPI:1942391164
Name:LUCIUS D. CLAY, III, M.D. PC
Entity Type:Organization
Organization Name:LUCIUS D. CLAY, III, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCIUS
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:434-947-3950
Mailing Address - Street 1:1900 TATE SPRINGS RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1122
Mailing Address - Country:US
Mailing Address - Phone:434-947-3950
Mailing Address - Fax:434-947-5914
Practice Address - Street 1:1900 TATE SPRINGS RD
Practice Address - Street 2:SUITE 3
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1122
Practice Address - Country:US
Practice Address - Phone:434-947-3950
Practice Address - Fax:434-947-5914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234666208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09767Medicare ID - Type UnspecifiedGROUP