Provider Demographics
NPI:1952363384
Name:CLAY, LOUISE BOWEN (MD)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:BOWEN
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:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:888-472-0043
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:2085 HENRY TECKLENBURG DR STE 106
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-7711
Practice Address - Country:US
Practice Address - Phone:843-958-2550
Practice Address - Fax:843-958-2599
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC217892085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC712893Medicaid
SCP00376337OtherRAILROAD MC
SCP00376337OtherRAILROAD MC
SC217893Medicaid