Provider Demographics
NPI:1487899357
Name:CLAY, JOHN R I (CERTIFIED PEDORTHIST)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:CLAY
Suffix:I
Gender:M
Credentials:CERTIFIED PEDORTHIST
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:R
Other - Last Name:CLAY
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:CPED
Mailing Address - Street 1:233 JOHNS ROAD
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-1650
Mailing Address - Country:US
Mailing Address - Phone:336-889-5909
Mailing Address - Fax:910-390-9002
Practice Address - Street 1:233 JOHNS ROAD
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-1650
Practice Address - Country:US
Practice Address - Phone:336-889-5909
Practice Address - Fax:910-390-9002
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X, 332BX2000X
NC7795381174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7701886Medicaid
NC7701886Medicaid
NC5599330001Medicare UPIN