Healthcare Provider Details

I. General information

NPI: 1982648788
Provider Name (Legal Business Name): WILLIAM RANDALL LAY III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 11/27/2023
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 NC 65
REIDSVILLE NC
27320
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR STE 100
CONCORD NC
28025-1831
US

V. Phone/Fax

Practice location:
  • Phone: 704-633-3616
  • Fax: 704-939-1173
Mailing address:
  • Phone: 704-633-3616
  • Fax: 704-939-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31163
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: