Provider Demographics
NPI:1144925025
Name:CLAY, WARREN LAMONT
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:LAMONT
Last Name:CLAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 FAIRMOUNT AVE NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-5220
Mailing Address - Country:US
Mailing Address - Phone:330-980-5160
Mailing Address - Fax:
Practice Address - Street 1:307 FAIRMOUNT AVE NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-5220
Practice Address - Country:US
Practice Address - Phone:330-980-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRT006257172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver