# CLAY COUNTY OUTPATIENT CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992988638
- **Authorized official:** ROBERTO S MAURICIO MD (PRESIDENT)
- **Authorized official phone:** (931) 243-3576

## Contact information

- **Practice address:** 102 OLD JEFFERSON STREET, CELINA, TN 38551-4040
- **Practice address phone:** (931) 243-3576
- **Practice address fax:** (931) 243-2751
- **Mailing address:** 102 OLD JEFFERSON STREET, CELINA, TN 38551-4040
- **Mailing address phone:** (931) 243-3576
- **Mailing address fax:** (931) 243-2751

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD7826 | TN | Yes |

## Other

- **Enumeration date:** 12/17/2007
- **Last updated:** 12/17/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3152445 | — | TN |