Provider Demographics
NPI:1306883582
Name:CLAY, JILL D (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:D
Last Name:CLAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:D
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:614-702-7899
Mailing Address - Fax:614-706-1570
Practice Address - Street 1:2260 MORSE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5858
Practice Address - Country:US
Practice Address - Phone:614-702-7899
Practice Address - Fax:614-706-1570
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-112485207R00000X
OH35.134968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI37597Medicare UPIN
ILK19827Medicare PIN