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General NPI Number Information
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NPI Number | 1164387106
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Entity Type | Organization
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Legal Business Name | HEADWAY NEURO, PLLC
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 3889 COBB PKWY NW
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City | ACWORTH
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State | GA
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Zip | 30101-4084
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Country | US
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Telephone | 404-665-3149
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Fax | 404-665-3149
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Provider Business Mailing Address
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Address Line | 4900 IVEY RD NW STE 815
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City | ACWORTH
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State | GA
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Zip | 30101-4001
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Country | US
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Telephone | 404-665-3149
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Fax | 404-665-3149
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Authorized Official
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Title or Position | MEMBER
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Name | DR. BRANDON ARTHUR MINES
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Credential | MD
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Telephone | 404-665-3149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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