Clayton Lively, M.D.
Individual provider Active NPI Psychiatry Physician · Moody Afb, GA
NPI 1407293418 · NPPES record last updated May 15, 2018
Key facts
- NPI
- 1407293418
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 28584 (NE)
- Practice address
- 3278 Mitchell Blvd
Moody Afb, GA 31699 - Phone
- (229) 257-1459
- NPI assigned
- May 30, 2013
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28584 | NE | MD | Psychiatry Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 28584 | NE | Yes |
Addresses
Primary practice location
3278 Mitchell Blvd
Moody Afb, GA 31699
Mailing address
3278 Mitchell Blvd
Moody Afb, GA 31699-1500
Phone (229) 257-1459
Other providers in Moody Afb, GA
- Leigh Ann Jones
- Shawn Philip Knight
- Kyle Michael Larson
- William Deleon Lawson
- Madia S Lee
- Laura Andrea Londono
- Hayley Lucero
- Salvatore Joseph Lucido
- Devon Lyons
- Stacy Madden
All providers in Moody Afb, GA · Psychiatry Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.