Healthcare Provider Details

I. General information

NPI: 1396454138
Provider Name (Legal Business Name): MENTAL WEALTH RESOURCES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2184 RIVER PARK CT
AUGUSTA GA
30907-2040
US

IV. Provider business mailing address

42 CARRIAGE OAKS DR # 1032
TYRONE GA
30290-1684
US

V. Phone/Fax

Practice location:
  • Phone: 470-400-7014
  • Fax:
Mailing address:
  • Phone: 470-400-7014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANKLIN EZEH
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 470-400-7014