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General NPI Number Information
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NPI Number | 1144953258
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Entity Type | Organization
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Legal Business Name | GEORGIA HEALTHY MINDS LLC
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 707 WHITLOCK AVE SW STE A40
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City | MARIETTA
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State | GA
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Zip | 30064-4654
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Country | US
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Telephone | 404-282-8530
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Fax |
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Provider Business Mailing Address
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Address Line | 5200 DALLAS HWY STE 200-193
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-6318
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Country | US
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Telephone | 678-939-6120
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Fax |
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Authorized Official
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Title or Position | CCO
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Name | JAYNE ANDRADE
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Credential | NP
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Telephone | 404-282-8530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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