MEDICARE: DR. KELLY ANNE CLAY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	21500	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457327181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY ANNE CLAY M.D.

Provider Business Mailing Address
First Line	:	6320 THE BLARNEY STONE
Second Line	:
City	:	RAVENEL
State	:	SC
Zip	:	29470-5240
Country	:	US
Telephone Number	:	843-889-1647
Fax Number	:

Provider Business Practice Location Address
First Line	:	2125 CHARLIE HALL BLVD
Second Line	:	SUITE - 2B
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5879
Country	:	US
Telephone Number	:	843-852-3151
Fax Number	:	843-573-1537

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	07/08/2007

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