Healthcare Provider Details

I. General information

NPI: 1235864646
Provider Name (Legal Business Name): AUDREY LYNN CLAY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 CHURCH ST
ROYSTON GA
30662-4434
US

IV. Provider business mailing address

819 CHURCH ST
ROYSTON GA
30662-4434
US

V. Phone/Fax

Practice location:
  • Phone: 706-245-6177
  • Fax: 706-245-6242
Mailing address:
  • Phone: 706-245-6177
  • Fax: 706-245-6242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN128901
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: