CLAYTON STATE UNIVERSITY NPI 1659758985

NPI Information

  • NPI: 1659758985
  • Provider Name: CLAYTON STATE UNIVERSITY
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • CLIA Number: 11D1028074
  • Address: 5809 NORTHLAKE DRIVE
    BLDG 1000
    MORROW, GA
    ZIP 30260
  • Phone: (678) 466-5590

Map and Directions

Get Directions

NPI Details

CLAYTON STATE UNIVERSITY is a family nurse practitioner in Morrow, GA. CLAYTON STATE UNIVERSITY NPI is 1659758985. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

5809 NORTHLAKE DRIVE
BLDG 1000
MORROW, GA
ZIP 30260
Phone: (678) 466-5590
Fax: (678) 466-4999

The provider's authorized official is Betty Susan Lane .
The authorized official title is Chair Nursing and has the following contact phone number (678) 466-4953.

The CLIA number assigned to this NPI record is 11D1028074 - school/student health service with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/6/2015 and was last updated on 12/4/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI