<Unavail>

LBN: Clayton Mhddad
<Unavail> is an health care organization with primary practice located at 4513 Ernest Dr Apt. # 1 & 3, Forest Park GA 30297-3566. The organization recently has only one registered license in Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center), which is considered as the primary health care specialty. Clayton Mhddad can be contacted via phone (404) 363-2063, or through Cole, Terry via phone (770) 478-2280.

Contact Information

Primary practice address
4513 Ernest Dr Apt. # 1 & 3 Forest Park GA 30297-3566
Phone: (404) 363-2063
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Cole, Terry
Phone: (770) 478-2280

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) 261QM0801X

Profile Details

NPI number 1629266473
LBN Legal business name Clayton Mhddad
DBA Doing business as <Unavail>
Authorized official Cole, Terry
Entity Organization
Organization subpart 1 Yes
Enumeration date Oct 5th, 2007
Last updated Nov 15th, 2011 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629266473 NPPES
Georgia MEDICAID 00604205L

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