Provider Demographics
NPI:1962531921
Name:CLAY, KIMBERLY DENISE (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DENISE
Last Name:CLAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 SPRUCE ST STE 305E
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3386
Mailing Address - Country:US
Mailing Address - Phone:704-671-6400
Mailing Address - Fax:704-671-6449
Practice Address - Street 1:2544 COURT DR STE A
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3450
Practice Address - Country:US
Practice Address - Phone:704-671-6400
Practice Address - Fax:704-671-6449
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01829207RE0101X, 207RE0101X
SC35264207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1962531921Medicaid
SCN01829Medicaid
SCP01141271OtherRAILROAD MEDICARE
SCN01829Medicaid
NC1962531921Medicaid
NC2577449Medicare PIN
NC2577449Medicare PIN