Healthcare Provider Details

I. General information

NPI: 1467092494
Provider Name (Legal Business Name): MIND & ENERGY PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 CALUMET PKWY BLDG F STE 201
NEWNAN GA
30263-6734
US

IV. Provider business mailing address

37 CALUMET PKWY BLDG F STE 201
NEWNAN GA
30263
US

V. Phone/Fax

Practice location:
  • Phone: 678-628-7156
  • Fax:
Mailing address:
  • Phone: 770-683-4538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: TAYANAU NUNEZ
Title or Position: CEO
Credential:
Phone: 770-683-4538