Organization
CLAYTON MHDDAD
Active
Other names
Clayton Center CSB
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JADE BENEFIELD (EXECUTIVE DIRECTOR)
(770) 478-2280
Entity
Organization
Contact information
Practice address
6944 FIELDER RD, REX, GA 30273-2414
(770) 478-2280
(770) 477-9772
Mailing address
112 BROAD ST, JONESBORO, GA 30236-3563
(770) 478-2280
(770) 477-9772
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000606922AG
—
GA
Enumeration date
08/11/2008
Last updated
08/11/2008
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