Healthcare Provider Details

I. General information

NPI: 1437451127
Provider Name (Legal Business Name): CLAYTON CENTER COMMUNITY SERVICE BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 BATTLECREEK RD
JONESBORO GA
30236-1919
US

IV. Provider business mailing address

853 BATTLECREEK ROAD
JONESBORO GA
30236
US

V. Phone/Fax

Practice location:
  • Phone: 770-478-1099
  • Fax: 770-478-8722
Mailing address:
  • Phone: 770-478-1099
  • Fax: 770-478-8722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberRN092487
License Number StateGA

VIII. Authorized Official

Name: MRS. JULIETTE MCGAHA
Title or Position: STAFF NURSE
Credential: RN
Phone: 770-478-1099