Healthcare Provider Details

I. General information

NPI: 1063321123
Provider Name (Legal Business Name): MAYFLOWER BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 WOODWARD WALK LN
SUWANEE GA
30024-4808
US

IV. Provider business mailing address

4420 WOODWARD WALK LN
SUWANEE GA
30024-4808
US

V. Phone/Fax

Practice location:
  • Phone: 229-669-5351
  • Fax:
Mailing address:
  • Phone: 229-669-5351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AZEEZAT SAMUEL
Title or Position: PMHNP
Credential:
Phone: 229-669-5351