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General NPI Number Information
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NPI Number | 1134106925
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Entity Type | Individual
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Provider Name | CLAY H WILSON MD
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Gender | Male
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 820 ST. SEBASTIAN WAY SUITE 8A
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City | AUGUSTA
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State | GA
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Zip | 30901
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Country | US
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Telephone | 706-722-6900
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Fax | 706-722-5118
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Provider Business Mailing Address
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Address Line | 820 ST. SEBASTIAN WAY SUITE 8A
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City | AUGUSTA
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State | GA
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Zip | 30901
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Country | US
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Telephone | 706-722-6900
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Fax | 706-722-5118
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 043510
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 13568
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License Number State | SC
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