NPIMap

Organization Active NPI

Clayton Mhddad

Doing business as Clayton CSB

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Forest Park, GA
National Provider Identifier
1629266473
Registry record updated Nov 15, 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 MHDDAD
Doing business as
Clayton CSB
Practice address
4513 Ernest Dr
Apt. # 1 & 3
Forest Park, GA 30297-3566
Phone
(404) 363-2063
NPI assigned
Oct 5, 2007
Last updated
Nov 15, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
CLAYTON MHDDADAs 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
Mr. Terry Cole
Title
Executive Director
Phone
(770) 478-2280

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary

Addresses

Primary practice location

4513 Ernest Dr
Apt. # 1 & 3
Forest Park, GA 30297-3566

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
00604205LMedicaidGA

Other names 1

  • Clayton CSB Doing business as

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

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": "1321315200000",
    "number": "1629266473",
    "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": "4513 ERNEST DR",
            "address_2": "APT. # 1 & 3",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302973566",
            "telephone_number": "404-363-2063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAYTON MHDDAD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLAYTON MHDDAD",
        "enumeration_date": "2007-10-05",
        "last_updated": "2011-11-15",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00604205L",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clayton CSB",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forest Park, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.