Innovative Clinical Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

INNOVATIVE CLINICAL SERVICES

Practice address

160 Kyndal Dr
Hampton, GA 30228-4862

Phone

(678) 826-6435

NPI assigned

Feb 7, 2012

Organization subpart

No

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

Authorized official

Name

Ms. Seanlonda N. Cooley

Title

Ceo/Owner

Phone

(678) 826-6435

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1328572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328572800000",
    "number": "1447522396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 KYNDAL DR",
            "city": "HAMPTON",
            "state": "GA",
            "postal_code": "302284862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 KYNDAL DR",
            "city": "HAMPTON",
            "state": "GA",
            "postal_code": "302284862",
            "telephone_number": "678-826-6435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE CLINICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-07",
        "last_updated": "2012-02-07",
        "status": "A",
        "authorized_official_last_name": "COOLEY",
        "authorized_official_first_name": "SEANLONDA",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "678-826-6435",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2012; 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.