Provider Demographics
NPI:1215901509
Name:LEE, CLAY A (DO)
Entity type:Individual
Prefix:
First Name:CLAY
Middle Name:A
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 DARLING AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-5246
Mailing Address - Country:US
Mailing Address - Phone:912-287-2513
Mailing Address - Fax:912-287-2532
Practice Address - Street 1:410 DARLING AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5246
Practice Address - Country:US
Practice Address - Phone:912-287-2513
Practice Address - Fax:912-287-2532
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046610207P00000X
GA46610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000848482AMedicaid
GA08BBQSRMedicare ID - Type UnspecifiedMEDICARE