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General NPI Number Information
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NPI Number | 1073233193
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Entity Type | Organization
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Legal Business Name | BLUEPRINT TMS& WELLNESS CENTERS OF AMERICA
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 1635 HIGHWAY 34 E # C2
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City | NEWNAN
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State | GA
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Zip | 30265-2173
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Country | US
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Telephone | 678-619-5151
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Fax |
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Provider Business Mailing Address
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Address Line | 1635 HIGHWAY 34 E # C2
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City | NEWNAN
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State | GA
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Zip | 30265-2173
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Country | US
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Telephone | 678-619-5151
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CRYSTAL NELSON
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Credential | MD
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Telephone | 404-859-2247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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