NPIMap

Organization Active NPI

Clayton Mhddad

  • Developmentally Disabled Services Day Training Agency
  • Jonesboro, GA
National Provider Identifier
1548458441
Registry record updated Nov 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
Legal business name
CLAYTON MHDDAD
Practice address
157 Smith St
Jonesboro, GA 30236-3546
Phone
(770) 478-2280
Fax
(770) 477-9772
NPI assigned
Oct 5, 2007
Organization subpart
Yes
Parent organization
CLAYTON MHDDADAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 8, 2011

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

Authorized official

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Developmentally Disabled Services Day Training Agency 251C00000X Primary
Community/Behavioral Health Agency 251S00000X
Clinic/Center 261Q00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

157 Smith St
Jonesboro, GA 30236-3546

Mailing address

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

Other identifiers 6

IdentifierTypeStateIssuer
00604205DMedicaidGA
00881218AMedicaidGA
00586176FMedicaidGA
00626249CMedicaidGA
00884056AMedicaidGA
00606922BMedicaidGA

Other names 1

  • Clayton CSB Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Clayton Mhddad34 organizations share this tax ID, including this one
Part of
Clayton Mhddad

Other organizations with this tax ID 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320710400000",
    "number": "1548458441",
    "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": "157 SMITH ST",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302363546",
            "telephone_number": "770-478-2280",
            "fax_number": "770-477-9772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAYTON MHDDAD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLAYTON MHDDAD",
        "enumeration_date": "2007-10-05",
        "last_updated": "2011-11-08",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "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
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00604205D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00881218A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00586176F",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00626249C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00884056A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00606922B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clayton CSB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jonesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2011; 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.