Healthcare Provider Details

I. General information

NPI: 1871394486
Provider Name (Legal Business Name): HALLWAYSMENTALHEALTHLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 CAROLETON DR
GROVETOWN GA
30813-0318
US

IV. Provider business mailing address

3711 EXECUTIVE CENTER DR STE 102-3
MARTINEZ GA
30907-0951
US

V. Phone/Fax

Practice location:
  • Phone: 216-269-2104
  • Fax:
Mailing address:
  • Phone: 706-262-4895
  • Fax: 801-730-1564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANDREA HALL
Title or Position: OWNER/PSYCHIATRIC NURSE PRACTITIONE
Credential: PMNHP
Phone: 706-262-4895