NPIMap

Organization Active NPI

Clayton Mhddad

Doing business as Clayton CSB

  • Community/Behavioral Health Agency
  • Jonesboro, GA
National Provider Identifier
1922296813
Registry record updated Nov 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CLAYTON MHDDAD
Doing business as
Clayton CSB
Practice address
217 Stockbridge Rd
Jonesboro, GA 30236-3628
Phone
(770) 471-4617
Fax
(770) 471-7817
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 12

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Adult Development & Aging PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TA0700X
Intellectual & Developmental Disabilities PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TM1800X
Developmentally Disabled Services Day Training Agency 251C00000X
Community/Behavioral Health Agency 251S00000X Primary
Clinic/Center 261Q00000X
Adult Day Care Clinic/Center 261QA0600X
Developmental Disabilities Clinic/Center 261QD1600X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Adult Mental Health Clinic/Center 261QM0850X

Addresses

Primary practice location

217 Stockbridge Rd
Jonesboro, GA 30236-3628

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
00395458AMedicaidGA
00604205GMedicaidGA

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

Locations

217 Stockbridge Rd
Jonesboro, GA 30236
Phone (770) 471-4617

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": "1922296813",
    "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": "217 STOCKBRIDGE RD",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302363628",
            "telephone_number": "770-471-4617",
            "fax_number": "770-471-7817"
        }
    ],
    "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": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Adult Development & Aging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "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
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00395458A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00604205G",
            "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 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.