NPIMap

Organization Active NPI

Clayton Community Mental Health Sa

Doing business as Clayton CSB

  • Community/Behavioral Health Agency
  • Conley, GA
National Provider Identifier
1124216825
Registry record updated Nov 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CLAYTON COMMUNITY MENTAL HEALTH SA
Doing business as
Clayton CSB
Practice address
1800 Slate Road
Conley, GA 30288-2014
Phone
(770) 478-2280
Fax
(770) 477-9772
NPI assigned
Oct 9, 2007
Last updated
Nov 15, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
CLAYTON COMMUNINTY MENTAL HEALTH SUBSTANCE ABUSE DEVE SVCS BOARDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 15, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Terry Cole
Title
Executive Director
Phone
(770) 478-2280

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X
Clinic/Center 261Q00000X
Adult Day Care Clinic/Center 261QA0600X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Adult Mental Health Clinic/Center 261QM0850X
Counselor 101Y00000X
Mental Health Counselor 101YM0800X
Psychologist 103T00000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1800 Slate Road
Conley, GA 30288-2014

Mailing address

157 Smith St
Jonesboro, GA 30236-3546
Phone (770) 478-2280

Other identifiers 1

IdentifierTypeStateIssuer
00604205AMedicaidGA

Other names 1

  • Clayton CSB Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040429000779 GA Part B Supplier - Clinic/Group Practice 3476540543 Receives reassigned benefits from 6 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jonesboro, GA; Morrow, GA

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Clayton Community Mental Health Sa34 organizations share this tax ID, including this one
Part of
Clayton Community Mental Health Sa

Other organizations with this tax ID 33

Organizations that report the same tax identification number in the National Provider Directory.

View all 33

Locations

1800 Slate Rd
Conley, GA 30288
Phone (404) 361-4229

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321315200000",
    "number": "1124216825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "157 SMITH ST",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302363546",
            "telephone_number": "770-478-2280",
            "fax_number": "770-477-9772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 SLATE ROAD",
            "city": "CONLEY",
            "state": "GA",
            "postal_code": "302882014",
            "telephone_number": "770-478-2280",
            "fax_number": "770-477-9772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAYTON COMMUNITY MENTAL HEALTH SA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLAYTON COMMUNINTY MENTAL HEALTH SUBSTANCE ABUSE DEVE SVCS BOARD",
        "enumeration_date": "2007-10-09",
        "last_updated": "2011-11-15",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "770-478-2280"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00604205A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clayton CSB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Conley, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.