Provider Demographics
NPI:1780614131
Name:CLAUD, EMMITT RAY JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:EMMITT
Middle Name:RAY
Last Name:CLAUD
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3810 CENTRAL PIKE
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3494
Mailing Address - Country:US
Mailing Address - Phone:815-744-8554
Mailing Address - Fax:
Practice Address - Street 1:201 BLUEBIRD DR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2301
Practice Address - Country:US
Practice Address - Phone:615-859-7546
Practice Address - Fax:615-851-7760
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN550363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3708943OtherGROUP MEDICARE NUMBER
TN3708943OtherGROUP MEDICARE NUMBER
TN3662991Medicare ID - Type Unspecified