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1043020662 NPI number — HEALTHY MINDS AND WELLNESS

NPI Number: 1043020662
Health Care Provider/Practitioner: HEALTHY MINDS AND WELLNESS

Information about “1043020662” NPI (HEALTHY MINDS AND WELLNESS) exists in 1043020662 in HTML format HTML  |  1043020662 in plain Text format TXT  |  1043020662 in PDF (Portable Document Format) PDF  |  1043020662 in an XML format XML  formats.

NPI Number : 1043020662 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043020662",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "HEALTHY MINDS AND WELLNESS",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2330 SCENIC HWY S STE 610",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SNELLVILLE",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30078-3115",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2330 SCENIC HWY S STE 610",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SNELLVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30078-3115",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-810-5836",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/08/2025",
    "LastUpdateDate": "01/08/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FULLER",
    "AuthorizedOfficialFirstName": "OMAR",
    "AuthorizedOfficialMiddleName": "KEVIN",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "NP",
    "AuthorizedOfficialTelephoneNumber": "973-572-8260",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LP0808X",
        "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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