Provider Demographics
NPI:1558254458
Name:CLAY, RUSSELL KEITH JR
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:KEITH
Last Name:CLAY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 SURREY LN SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-5330
Mailing Address - Country:US
Mailing Address - Phone:678-628-8431
Mailing Address - Fax:
Practice Address - Street 1:5680 FULTON INDUSTRIAL BLVD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30336-2659
Practice Address - Country:US
Practice Address - Phone:404-346-3471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty