Organization
CLAYTON MHDDAD
Active
Other names
Clayton CSB
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY COLE (CEO)
(770) 478-2280
Entity
Organization
Contact information
Practice address
1585 PINTAIL RD, JONESBORO, GA 30238-6641
(770) 478-2280
Mailing address
112 BROAD ST, JONESBORO, GA 30236-3563
(770) 478-2280
(770) 477-9772
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00606922AQ
—
GA
Enumeration date
09/23/2010
Last updated
09/23/2010
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