Healthcare Provider Details

I. General information

NPI: 1790605822
Provider Name (Legal Business Name): BRAVE MINDS WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 NEWNAN CROSSING BYP FL 2
NEWNAN GA
30265-2323
US

IV. Provider business mailing address

354 NEWNAN CROSSING BYP STE 235
NEWNAN GA
30265-2435
US

V. Phone/Fax

Practice location:
  • Phone: 470-995-5469
  • Fax: 406-289-9609
Mailing address:
  • Phone: 470-995-5469
  • Fax: 406-289-9609

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: DORTHEA ROGERS
Title or Position: OWNER
Credential: APRN
Phone: 470-995-5469