Provider Demographics
NPI:1245881879
Name:LANDRUM, CLAYTON M (BCBA, MEDECE)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:M
Last Name:LANDRUM
Suffix:
Gender:M
Credentials:BCBA, MEDECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2579 SYLVAN RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6743
Mailing Address - Country:US
Mailing Address - Phone:678-463-3443
Mailing Address - Fax:
Practice Address - Street 1:9559 HIGHWAY 5 STE 601
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1572
Practice Address - Country:US
Practice Address - Phone:470-632-5276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-19-37655103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst