Provider Demographics
NPI:1316111024
Name:CLAY, JOHN PAUL (PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:CLAY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 HOSPITAL DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2454
Mailing Address - Country:US
Mailing Address - Phone:276-236-5181
Mailing Address - Fax:
Practice Address - Street 1:199 HOSPITAL DR
Practice Address - Street 2:SUITE 7
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2454
Practice Address - Country:US
Practice Address - Phone:276-236-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-002747363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical