Healthcare Provider Details

I. General information

NPI: 1518644459
Provider Name (Legal Business Name): MAXIMIZED MENTALITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/03/2023
Certification Date: 07/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3295 RIVER EXCHANGE DR STE 211
NORCROSS GA
30092-4204
US

IV. Provider business mailing address

5330 BROOKSTONE DR NW STE 250
ACWORTH GA
30101-7183
US

V. Phone/Fax

Practice location:
  • Phone: 770-405-9855
  • Fax:
Mailing address:
  • Phone: 770-405-9855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TREMEZE JACKSON
Title or Position: CEO/NURSE PRACTITIONER
Credential: DNP,PMHNP-BC, FNP-C
Phone: 770-405-9855