CLAYTON MHDDAD (NPI# 1639367543) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639367543 |
| Entity Type | Organization |
| Organization Name | CLAYTON MHDDAD |
| Other Organization Name | CLAYTON CSB |
| Practice Address |
6315 Garden Walk Blvd Riverdale GA 30274-2628 |
| Mailing Address |
157 Smith St Jonesboro GA 30236-3546 |
| Practice Telephone | 7709917420 |
| Practice Fax Number | 7709917429 |
| Mailing Telephone | 7704782280 |
| Mailing Fax Number | 7704779772 |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2011-11-08 |
| Authorized Official Name | MR. TERRY COLE (EXCUTIVE DIRECTOR) |
| Authorized Official Telephone | 7704782280 |
| Is Organization Subpart | Y |
| Parent Organization Name | CLAYTON MHDDAD |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities | ||
| N | 251C00000X | Day Training, Developmentally Disabled Services | Agencies | ||
| N | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities | ||
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities | ||
| N | 101Y00000X | Counselor | Behavioral Health & Social Service Providers | ||
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
Behavioral Health & Social Service Providers | ||
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00604205B | 05 | |
| GA | 000604250B | 05 |
| Other Name | Type Code |
|---|---|
| Clayton CSB | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518113869 | Clayton Mhddad | Community/Behavioral Health | 1044 Pinecrest Dr, Forest Park, GA 30297-3335 | 2008-08-18 |
| 1427204775 | Clayton Mhddad | Community/Behavioral Health | 6278 Holiday Blvd, Forest Park, GA 30297-4262 | 2008-08-18 |
| 1386890341 | Clayton Mhddad | Community/Behavioral Health | 6944 Fielder Rd, Rex, GA 30273-2414 | 2008-08-11 |
| 1104082866 | Clayton Mhddad | Community/Behavioral Health | 269 Valley Hill Rd Sw, Riverdale, GA 30274-2745 | 2008-08-01 |
| 1639358906 | Clayton Mhddad | Clinic/Center | 1585 Pintail Rd, Jonesboro, GA 30238-6641 | 2007-11-02 |
| 1679761373 | Clayton Mhddad | Clinic/Center | 2081 Logan Dr, Jonesboro, GA 30236-7215 | 2007-10-09 |
| 1942498647 | Clayton Mhddad | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5800 Lillian Ln, Morrow, GA 30260-3965 | 2007-10-09 |
| 1851589550 | Clayton Mhddad | Clinic/Center | 7814 Fielder Rd, Jonesboro, GA 30236-2610 | 2007-10-09 |
| 1588852289 | Clayton Mhddad | Clinic/Center | 5818 Thompson Blvd, Morrow, GA 30260-3910 | 2007-10-09 |
| 1497943104 | Clayton Mhddad | Clinic/Center | 901 Walnut Creek Ln, Jonesboro, GA 30238-6465 | 2007-10-09 |
| Street Address |
6315 GARDEN WALK BLVD |
| City | RIVERDALE |
| State | GA |
| Zip Code | 30274-2628 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659415917 | Ann Lorene Brock | Psychologist | 6315 Garden Walk Blvd, Riverdale, GA 30274-2628 | 2007-02-19 |
| 1265791537 | Lakeitha Howard | Counselor | 6315 Garden Walk Blvd, Riverdale, GA 30274-2628 | 2012-05-08 |
| 1699052217 | Ashley Kemp | Counselor | 6315 Garden Walk Blvd, Riverdale, GA 30274-2628 | 2011-11-10 |
| 1699097303 | Velecia Velencia Mcdowell | Counselor | 6315 Garden Walk Blvd, Riverdale, GA 30274-2628 | 2010-02-22 |
| 1689801987 | Michelle A Nix | Counselor | 6315 Garden Walk Blvd, Riverdale, GA 30274-2628 | 2009-06-15 |
| 1356584304 | Rhonda Denise Cooper | Registered Nurse | 6315 Garden Walk Blvd, Riverdale, GA 30274-2628 | 2009-04-07 |
| 1194929117 | Rosalyn M. Garner | Social Worker | 6315 Garden Walk Blvd, Riverdale, GA 30274-2628 | 2007-06-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245862507 | Todd L. Reed | Chiropractor | 83 Upper Riverdale Rd, Riverdale, GA 30274 | 2020-02-05 |
| 1487135992 | Freddie L Sallette IIi | Technician, Pathology | 385 Brookview Dr, Riverdale, GA 30274 | 2018-08-22 |
| 1366933210 | Dawn A. Paul | Nurse Practitioner | 238 Professional Ct Ste A, Riverdale, GA 30274 | 2018-05-27 |
| 1851894588 | Absolute Health Family & Urgent Care Clinic | Clinic/Center | 7574 Ga 85, Riverdale, GA 30274 | 2018-03-08 |
| 1366972127 | Jamillah Ingram | Physical Therapy Assistant | 315 Upper Riverdale Rd., Riverdale, GA 30274 | 2017-06-14 |
| 1114456514 | Grace L Kelson | Licensed Practical Nurse | 9142 Clubhouse Dr, Riverdale, GA 30274 | 2017-06-08 |
| 1790167799 | Cristian Carbuccia | Internal Medicine | 33 Upper Riverdale Rd Sw Ste 10, Riverdale, GA 30274 | 2015-06-25 |
| 1265857692 | Right Choice Enterprises LLC | Technician | 638 Sterling Ct, Riverdale, GA 30274 | 2014-02-21 |
| 1942571625 | Lowes Guardian Angel LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7056 Eunice Dr., Riverdale, GA 30274 | 2012-01-26 |
| 1508134156 | Education System Management, Inc | Social Worker | 125 Highway 138, Riverdale, GA 30274 | 2011-12-12 |
| Find all providers in zip 30274 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790290377 | Your Support Service | Community/Behavioral Health | 6309 Baltimore Ave Ste 201, Riverdale, MD 20737-1059 | 2017-12-05 |
| 1326307257 | A Affordable Dui School LLC | Community/Behavioral Health | 6360 Highway 85, Riverdale, GA 30274-1609 | 2012-05-12 |
| 1407131097 | Global Matrix International Inc. | Community/Behavioral Health | 6030 Hwy 85 Ste 202-4, Riverdale, GA 30274 | 2011-10-15 |
| 1114229440 | Angels Around Us | Community/Behavioral Health | 8915 Creekwood Ct, Riverdale, GA 30274-4601 | 2010-11-18 |
| 1013249283 | Panacea Counseling Services LLC | Community/Behavioral Health | 1436 King Rd, Riverdale, GA 30296-2915 | 2010-02-12 |
| 1568796001 | Ucan | Community/Behavioral Health | 13700 S Indiana Ave, Riverdale, IL 60827-1842 | 2009-10-01 |
| 1023242096 | Tranquility Health Incorporated | Community/Behavioral Health | 113 Upper Riverdale Road, Riverdale, GA 30274 | 2009-05-06 |
| 1104082866 | Clayton Mhddad | Community/Behavioral Health | 269 Valley Hill Rd Sw, Riverdale, GA 30274-2745 | 2008-08-01 |
| 1982888640 | Kiya Club Comprehensive Treatment Center | Community/Behavioral Health | 1258 Highway 138 Sw, Riverdale, GA 30296-1402 | 2007-12-18 |
| 1275713174 | My Sister's Keeper Family Services, Inc. | Community/Behavioral Health | 804 Commerce Blvd Ste A8, Riverdale, GA 30296-3321 | 2007-11-07 |
| Find all providers in RIVERDALE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.