Clayton State University

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CLAYTON STATE UNIVERSITY

Doing business as

clayton state sports medicine

Practice address

2000 Clayton State Blvd
Morrow, GA 30260-1250

Phone

(678) 466-4692

Fax

(972) 367-3451

NPI assigned

Jan 20, 2015

Last updated

Jan 20, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mouzon Bass III

Title

Agent

Phone

(800) 555-9073

Specialties & licenses 2

Addresses

Other names 1

• clayton state sports medicine Doing business as

Tax ID family

Clayton State Athletics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Clayton State University

  • Athletic Trainer
  • Morrow, GA
  • NPI 1154486884
  NPD tax ID

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

{
    "created_epoch": "1421712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421712000000",
    "number": "1962891556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 SPRING VALLEY RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752443995",
            "telephone_number": "800-555-9073",
            "fax_number": "972-367-3452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 CLAYTON STATE BLVD",
            "city": "MORROW",
            "state": "GA",
            "postal_code": "302601250",
            "telephone_number": "678-466-4692",
            "fax_number": "972-367-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLAYTON STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-20",
        "last_updated": "2015-01-20",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "MOUZON",
        "authorized_official_title_or_position": "AGENT",
        "authorized_official_telephone_number": "18005559073",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "clayton state sports medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Clayton County Public Schools
• Clayton Mhddad (Clayton CSB)
• Clayton Mhddad (Clayton CSB)
• Clayton State University
• Clayton State University
• CLR Personal Home Care, LLC
• Angela E. Cochran, RN
• Willie Cochran Jr., MD
• Cognitive Healing of Atlanta LLC
• Terry Cole, LPC, MAC, CCS

• Family Medicine Physician in Morrow, GA
• Providers in Morrow, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2015; 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.