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. JADE BENEFIELD (EXCUTIVE DIRECTOR)
(770) 478-2280
Entity
Organization
Contact information
Practice address
5800 LILLIAN LN, MORROW, GA 30260-3965
(404) 363-2995
Mailing address
112 BROAD ST, JONESBORO, GA 30236-3563
(770) 478-2280
(770) 477-9772
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00607076B
—
GA
Enumeration date
10/09/2007
Last updated
03/05/2008
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