Provider Demographics
NPI:1174788079
Name:ROBERT DOUGLAS CLAYTON, MD. PC.
Entity type:Organization
Organization Name:ROBERT DOUGLAS CLAYTON, MD. PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-205-0525
Mailing Address - Street 1:4060 JOHNS CREEK PKWY
Mailing Address - Street 2:BLDG F
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1230
Mailing Address - Country:US
Mailing Address - Phone:678-205-0525
Mailing Address - Fax:770-604-9316
Practice Address - Street 1:4060 JOHNS CREEK PKWY
Practice Address - Street 2:BLDG F
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1230
Practice Address - Country:US
Practice Address - Phone:678-205-0525
Practice Address - Fax:770-604-9316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000517338CMedicaid
GA511G700888OtherMEDICARE
GA9210293OtherCIGNA
GAC34742Medicare UPIN