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General NPI Number Information
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NPI Number | 1720453905
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Entity Type | Organization
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Legal Business Name | CLAYTOR MEMORIAL CLINIC
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Dates
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Enumeration Date | 12/14/2015
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Last Update Date | 12/14/2015
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Provider Practice Location Address
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Address Line | 1625 FRANKLIN ST
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City | ROCKY MOUNT
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State | VA
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Zip | 24151-6390
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Country | US
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Telephone | 844-543-9362
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Fax |
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Provider Business Mailing Address
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Address Line | 1625 FRANKLIN ST
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City | ROCKY MOUNT
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State | VA
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Zip | 24151-6390
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Country | US
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Telephone | 844-543-9362
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD LAMONT CLAYTOR JR.
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Credential | MD
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Telephone | 540-598-6321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 0101055727
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License Number State | VA
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