Basic Information
| Provider Information | |||||||||
| NPI: | 1710991419 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH CLAY MEDICAL ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3360 COUNTY ROAD 220 | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320684359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042912221 | ||||||||
| FaxNumber: | 9042919192 | ||||||||
| Practice Location | |||||||||
| Address1: | 3360 COUNTY ROAD 220 | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320684359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042912221 | ||||||||
| FaxNumber: | 9042919192 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 05/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | AL-AWADY | ||||||||
| AuthorizedOfficialFirstName: | MURSHID | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9042912221 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.