Provider Demographics
NPI:1881779510
Name:CLAY, VALENCIA (MD)
Entity type:Individual
Prefix:MS
First Name:VALENCIA
Middle Name:
Last Name:CLAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-4246
Mailing Address - Country:US
Mailing Address - Phone:423-892-4289
Mailing Address - Fax:
Practice Address - Street 1:4411 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-2367
Practice Address - Country:US
Practice Address - Phone:423-892-4289
Practice Address - Fax:423-553-1829
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38244207R00000X
GA40348207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G23160Medicare UPIN
3892066Medicare ID - Type Unspecified