Organization
CLAYTON MHDDAD
Active
Parent organization
CLAYTON MHDDAD
Other names
Clayton CSB
Organization subpart
Yes
Provider details
NPI number
Legal business name
CLAYTON MHDDAD
Authorized official
MR. TERRY COLE (EXECUTIVE DIRECTOR)
(770) 478-2280
Entity
Organization
Contact information
Practice address
8132 KENDRICK RD, B&C, JONESBORO, GA 30238-2933
(770) 471-5249
(770) 477-9772
Mailing address
157 SMITH ST, JONESBORO, GA 30236-3546
(770) 478-2280
(770) 477-9772
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00604205Q
—
GA
Enumeration date
10/09/2007
Last updated
11/08/2011
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