Healthcare Provider Details

I. General information

NPI: 1982956454
Provider Name (Legal Business Name): WENDY BARNES-MELLSTROM R.N, B.S.N, M.S.N,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 11/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PEACHFORD RD
ATLANTA GA
30338
US

IV. Provider business mailing address

2150 PEACHFORD RD
ATLANTA GA
30338-6520
US

V. Phone/Fax

Practice location:
  • Phone: 770-330-8001
  • Fax:
Mailing address:
  • Phone: 770-330-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number363LP0808X
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: