Provider Demographics
NPI:1477525699
Name:CLAYTON, BUDDY J (MD)
Entity type:Individual
Prefix:DR
First Name:BUDDY
Middle Name:J
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1497 W ELK AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2895
Mailing Address - Country:US
Mailing Address - Phone:423-542-8929
Mailing Address - Fax:423-542-8621
Practice Address - Street 1:1497 W ELK AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2895
Practice Address - Country:US
Practice Address - Phone:423-542-8929
Practice Address - Fax:423-542-8621
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD26900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3098929Medicaid
VA1477525699Medicaid
TN3098921Medicaid
TNQ003262Medicaid
TN080135081OtherRAILROAD MEDICARE
TN1505556Medicaid
TN103I081323Medicare PIN
TN3001429Medicare PIN
TN1505556Medicaid
TNQ003262Medicaid
TN30989201Medicare PIN
TN3098926Medicare PIN