MEDICARE: CLAYTON COMMUNITY MENTAL HEALTH SA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	261Q00000X	Clinic/Center
4	261QA0600X	Adult Day Care Clinic/Center
5	261QM0850X	Adult Mental Health Clinic/Center
6	101Y00000X	Counselor
7	101YM0800X	Mental Health Counselor
8	103T00000X	Psychologist
9	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124216825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAYTON COMMUNITY MENTAL HEALTH SA

Provider Business Mailing Address
First Line	:	157 SMITH ST
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30236-3546
Country	:	US
Telephone Number	:	770-478-2280
Fax Number	:	770-477-9772

Provider Business Practice Location Address
First Line	:	1800 SLATE ROAD
Second Line	:
City	:	CONLEY
State	:	GA
Zip	:	30288-2014
Country	:	US
Telephone Number	:	770-478-2280
Fax Number	:	770-477-9772

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	TERRY COLE
Credential	:
Telephone Number	:	770-478-2280

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	11/15/2011

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Directions to “CLAYTON COMMUNITY MENTAL HEALTH SA ” Practice Location

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