=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104646116
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THINK JOY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2024
-----------------------------------------------------
Last Update Date | 10/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 969 MCDONALD RD
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30014-5761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-410-8784
-----------------------------------------------------
Fax | 470-410-8705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7032
-----------------------------------------------------
City | CHESTNUT MOUNTAIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30502-0032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MRS. KAITLYN MCMILLIAN
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 470-410-8784
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------