Active NPI
Clay H Wilson, MD
- Nephrology Physician
- Augusta, GA
National Provider Identifier
1134106925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- 043510
- Practice address
- 820 St. Sebastian Way
Suite 8a
Augusta, GA 30901 - Phone
- (706) 722-6900
- Fax
- (706) 722-5118
- NPI assigned
- Dec 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 043510 | GA | Primary |
| Nephrology Physician | 207RN0300X | 13568 | SC |
Addresses
Primary practice location
820 St. Sebastian Way
Suite 8a
Augusta, GA 30901
Mailing address
820 St. Sebastian Way
Suite 8a
Augusta, GA 30901
Phone (706) 722-6900
Other identifiers 20
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000749911AC | Medicaid | GA | |
| 000749911M | Medicaid | GA | |
| 338224 | Other | GA | WELLCARE OF GA |
| 000749911AE | Medicaid | GA | |
| 000749911AF | Medicaid | GA | |
| 000749911K | Medicaid | GA | |
| 000749911P | Medicaid | GA | |
| 000951915E | Medicaid | GA | |
| 10058037 | Other | GA | AMERIGROUP |
| 1134106925 | Other | GA | BCBS-GA |
| G43510 | Medicaid | SC | |
| 000749911A | Medicaid | GA | |
| 000749911AB | Medicaid | GA | |
| 000749911AD | Medicaid | GA | |
| 000749911AG | Medicaid | GA | |
| 000951915B | Medicaid | GA | |
| 000951915C | Medicaid | GA | |
| 000749911AH | Medicaid | GA | |
| 000749911AI | Medicaid | GA | |
| 390005010 | Other | GA | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- nephrologyassociates@ppdxdirect.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415145600000",
"number": "1134106925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 ST. SEBASTIAN WAY",
"address_2": "SUITE 8A",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "30901",
"telephone_number": "706-722-6900",
"fax_number": "706-722-5118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 ST. SEBASTIAN WAY",
"address_2": "SUITE 8A",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "30901",
"telephone_number": "706-722-6900",
"fax_number": "706-722-5118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CLAY",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-22",
"last_updated": "2014-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "GA",
"license": "043510",
"primary": true
},
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "SC",
"license": "13568",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000749911AC",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000749911M",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE OF GA",
"identifier": "338224",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000749911AE",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000749911AF",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000749911K",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000749911P",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000951915E",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP",
"identifier": "10058037",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS-GA",
"identifier": "1134106925",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "G43510",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000749911A",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000749911AB",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000749911AD",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000749911AG",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000951915B",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000951915C",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000749911AH",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000749911AI",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "390005010",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.