Healthcare Provider Details

I. General information

NPI: 1164387106
Provider Name (Legal Business Name): HEADWAY NEURO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3889 COBB PKWY NW
ACWORTH GA
30101-4084
US

IV. Provider business mailing address

4900 IVEY RD NW STE 815
ACWORTH GA
30101-4001
US

V. Phone/Fax

Practice location:
  • Phone: 404-665-3149
  • Fax: 404-665-3149
Mailing address:
  • Phone: 404-665-3149
  • Fax: 404-665-3149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDON ARTHUR MINES
Title or Position: MEMBER
Credential: MD
Phone: 404-665-3149