Clayton State University

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Legal business name

CLAYTON STATE UNIVERSITY

Practice address

2000 Clayton State Boulevard
Morrow, GA 30260-0285

Phone

(678) 466-5257

Fax

(678) 466-4699

NPI assigned

Dec 22, 2006

Organization subpart

No

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

Authorized official

Name

Ryan Erlacher

Title

Athletic Director

Phone

(678) 466-4672

Specialties & licenses 1

Addresses

Other names 1

• Clayton State Athletics Other name

Tax ID family

Clayton State Athletics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Clayton State University

  • Family Medicine Physician
  • Morrow, GA
  • NPI 1962891556
  NPD tax ID

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580169600000",
    "number": "1154486884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 CLAYTON STATE BLVD",
            "city": "MORROW",
            "state": "GA",
            "postal_code": "302601250",
            "telephone_number": "678-466-5257",
            "fax_number": "678-466-4699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 CLAYTON STATE BOULEVARD",
            "city": "MORROW",
            "state": "GA",
            "postal_code": "302600285",
            "telephone_number": "678-466-5257",
            "fax_number": "678-466-4699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAYTON STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A",
        "authorized_official_last_name": "ERLACHER",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "ATHLETIC DIRECTOR",
        "authorized_official_telephone_number": "678-466-4672"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clayton State Athletics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Clayton Center Mhaddd
• Clayton County Juvenile Justice Fund
• Clayton County Public Schools
• Clayton Mhddad
• Clayton Mhddad
• Clayton State University
• Clayton State University
• CLR Personal Home Care, LLC
• Angela E. Cochran, RN
• Willie Cochran Jr., MD

• All providers in Morrow, GA
• Athletic Trainer in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.