Individual
CLAY N STALLWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
905 15TH ST, AUGUSTA, GA 30901-0615
(706) 721-3125
(706) 312-5427
Mailing address
1499 WALTON WAY, STE 1400, AUGUSTA, GA 30901-2602
(706) 724-6100
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
047847
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000868194A
—
GA
05
—
G47847
—
SC
Enumeration date
08/31/2006
Last updated
12/03/2012
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