Healthcare Provider Details

I. General information

NPI: 1417004136
Provider Name (Legal Business Name): MARK ANTHONY CLAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
JEFFERSON LA
70121-2451
US

IV. Provider business mailing address

1514 JEFFERSON HWY
JEFFERSON LA
70121-2451
US

V. Phone/Fax

Practice location:
  • Phone: 770-289-7336
  • Fax: 615-468-4520
Mailing address:
  • Phone: 770-289-7336
  • Fax: 615-468-4520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number351496
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number351496
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberN6842
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberN6842
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number351496
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: