Active NPI
Clayton Faircloth, MS, ATC, LAT
- Athletic Trainer
- Milledgeville, GA
National Provider Identifier
1922557735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT002924
- Practice address
- 208 Ivey Dr SW
Milledgeville, GA 31061-3760 - Phone
- (912) 687-1080
- NPI assigned
- Sep 22, 2016
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT002924 | GA | Primary |
Addresses
Primary practice location
208 Ivey Dr SW
Milledgeville, GA 31061-3760
Mailing address
208 Ivey Dr SW
Milledgeville, GA 31061-3760
Phone (912) 687-1080
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)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT002924 | GA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474502400000",
"number": "1922557735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "208 IVEY DR SW",
"city": "MILLEDGEVILLE",
"state": "GA",
"postal_code": "310613760",
"telephone_number": "912-687-1080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 IVEY DR SW",
"city": "MILLEDGEVILLE",
"state": "GA",
"postal_code": "310613760",
"telephone_number": "912-687-1080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRCLOTH",
"first_name": "CLAYTON",
"credential": "MS, ATC, LAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-22",
"last_updated": "2016-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "GA",
"license": "AT002924",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milledgeville, GA
- Rachel Evans
- Randall Keith Evans, P.T.
- Steven Patrick Everett, ATC
- Excell Home Care Services,Inc
- Eye Care Associates of Middle Ga
- Frederick Steven Falchook, M.D.
- Family Eyecare Associates of Milledgeville, PC
- Family Eyecare Associates of Milledgeville, PC
- Family Tree Counseling and Training Center LLC
- Andrea Holland Farmer
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.