NPIMap

Organization Active NPI

Clayton Community Mental Health Substance Ab

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jonesboro, GA
National Provider Identifier
1609024157
Registry record updated Mar 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
CLAYTON COMMUNITY MENTAL HEALTH SUBSTANCE AB
Practice address
853 Battlecreek Rd
Jonesboro, GA 30236-1919
Phone
(770) 478-1099
Fax
(770) 478-8722
NPI assigned
Sep 8, 2008
Organization subpart
Yes
Parent organization
CLAYTON COMMUNITY MENTAL HEALTH SUBSTANCE ABUSE DEVE SVCS BOARDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 4, 2011

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

Authorized official

Name
Marketeia Gant
Title
Cfo
Phone
(770) 605-1126

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Adult Mental Health Clinic/Center 261QM0850X GA

Addresses

Primary practice location

853 Battlecreek Rd
Jonesboro, GA 30236-1919

Mailing address

112 Broad St
Jonesboro, GA 30236-3563
Phone (770) 478-2280

Other identifiers 2

IdentifierTypeStateIssuer
00604205EMedicaidGA
GRP2322OtherGAMEDICARE

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 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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1220832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299196800000",
    "number": "1609024157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 BROAD ST",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302363563",
            "telephone_number": "770-478-2280",
            "fax_number": "770-478-8722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "853 BATTLECREEK RD",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302361919",
            "telephone_number": "770-478-1099",
            "fax_number": "770-478-8722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAYTON COMMUNITY MENTAL HEALTH SUBSTANCE AB",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLAYTON COMMUNITY MENTAL HEALTH SUBSTANCE ABUSE DEVE SVCS BOARD",
        "enumeration_date": "2008-09-08",
        "last_updated": "2011-03-04",
        "status": "A",
        "authorized_official_last_name": "GANT",
        "authorized_official_first_name": "MARKETEIA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "770-605-1126"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "GA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00604205E",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "GRP2322",
            "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 Mar 4, 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.