Healthcare Provider Details

I. General information

NPI: 1487700654
Provider Name (Legal Business Name): MENTAL FITNESS & BEYOND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 WEATHERSTONE DR NE
ATLANTA GA
30324-4644
US

IV. Provider business mailing address

1276 WEATHERSTONE DR NE
ATLANTA GA
30324-4644
US

V. Phone/Fax

Practice location:
  • Phone: 404-320-7045
  • Fax:
Mailing address:
  • Phone: 404-320-7045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number13415401
License Number StateGA

VIII. Authorized Official

Name: BARBARA B. ANDERSON
Title or Position: PRINCIPAL
Credential: RNMNCS
Phone: 404-320-7045