NPIMap

Organization Active NPI

Clayton Mhddad

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jonesboro, GA
National Provider Identifier
1639358906
Registry record updated Mar 5, 2008
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
Practice address
1585 Pintail Rd
Jonesboro, GA 30238-6641
Phone
(770) 471-2136
NPI assigned
Nov 2, 2007
Organization subpart
Yes
Parent organization
CLAYTON MHDDADAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 5, 2008

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

Authorized official

Name
Mr. Jade Benefield
Title
Executive Director
Phone
(770) 478-2280

Specialties & licenses 1

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

Addresses

Primary practice location

1585 Pintail Rd
Jonesboro, GA 30238-6641

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
00606922AAMedicaidGA

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": "1193961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204675200000",
    "number": "1639358906",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1585 PINTAIL RD",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302386641",
            "telephone_number": "770-471-2136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAYTON MHDDAD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLAYTON MHDDAD",
        "enumeration_date": "2007-11-02",
        "last_updated": "2008-03-05",
        "status": "A",
        "authorized_official_last_name": "BENEFIELD",
        "authorized_official_first_name": "JADE",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00606922AA",
            "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 5, 2008; 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.