Healthcare Provider Details

I. General information

NPI: 1942124151
Provider Name (Legal Business Name): SERENITY MIND AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 WYMAN ST STE 300
WALTHAM MA
02451-1255
US

IV. Provider business mailing address

3276 BUFORD DR STE 104-131
BUFORD GA
30519-5702
US

V. Phone/Fax

Practice location:
  • Phone: 404-453-2337
  • Fax:
Mailing address:
  • Phone: 404-453-2337
  • Fax:

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: JACKIE K ZZIWA
Title or Position: MEMBER
Credential: PMHNP-BC
Phone: 404-453-2337