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General NPI Number Information
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NPI Number | 1154131415
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Entity Type | Organization
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Legal Business Name | MINDWELL PLLC
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 2700 COLTSGATE RD STE 106
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City | CHARLOTTE
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State | NC
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Zip | 28211-3573
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Country | US
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Telephone | 864-735-5357
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Fax |
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Provider Business Mailing Address
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Address Line | 16 MILLS AVE STE 6
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City | GREENVILLE
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State | SC
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Zip | 29605-4065
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Country | US
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Telephone | 864-735-5357
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAROD MOTLEY
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Credential | MD
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Telephone | 864-735-5357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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