Healthcare Provider Details

I. General information

NPI: 1760969018
Provider Name (Legal Business Name): CLAYTON ROSS TAPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 US HIGHWAY 41 N
TIFTON GA
31794-2749
US

IV. Provider business mailing address

12294 HIGHWAY 41
SPARKS GA
31647-6520
US

V. Phone/Fax

Practice location:
  • Phone: 229-391-4080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP249392
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: