MEDICARE: MENDA BEHAVIORAL HEALTH SERVICES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1326813387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENDA BEHAVIORAL HEALTH SERVICES PC

Provider Business Mailing Address
First Line	:	1303 PENDLETON ST SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-3801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 PENDLETON ST SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-3801
Country	:	US
Telephone Number	:	323-776-3632
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PHILLIP A MITCHELL
Credential	:	MD
Telephone Number	:	323-776-3632

Provider Enumeration Date	:	11/20/2023
Last Update Date	:	06/11/2026

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