NPIMap

Organization Active NPI

Clayton Mhddad

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jonesboro, GA
National Provider Identifier
1992984264
Registry record updated Jun 10, 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
217 Stockbridge Rd
Jonesboro, GA 30236-3628
Phone
(770) 471-4617
Fax
(770) 471-7817
NPI assigned
Nov 2, 2007
Organization subpart
Yes
Parent organization
CLAYTON MHDDADAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 10, 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 11

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X
Developmentally Disabled Services Day Training Agency 251C00000X
Community/Behavioral Health Agency 251S00000X
Clinic/Center 261Q00000X
Adult Day Care Clinic/Center 261QA0600X
Community Health Clinic/Center 261QC1500X
Developmental Disabilities Clinic/Center 261QD1600X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Adult Mental Health Clinic/Center 261QM0850X

Addresses

Primary practice location

217 Stockbridge Rd
Jonesboro, GA 30236-3628

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
00607076DMedicaidGA

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": "1213056000000",
    "number": "1992984264",
    "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": "770-477-9772"
        },
        {
            "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": "2007-11-02",
        "last_updated": "2008-06-10",
        "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": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "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": false
        },
        {
            "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": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "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": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00607076D",
            "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 Jun 10, 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.