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General NPI Number Information
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NPI Number | 1215657853
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Entity Type | Organization
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Legal Business Name | HEALING MIND AND BODY LLC
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Dates
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Enumeration Date | 09/02/2022
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Last Update Date | 09/03/2022
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Provider Practice Location Address
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Address Line | 2225 GODBY RD STE B200
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City | COLLEGE PARK
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State | GA
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Zip | 30349-5012
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Country | US
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Telephone | 678-764-8919
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Fax |
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Provider Business Mailing Address
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Address Line | 105 BANKS STA STE 1120
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7503
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Country | US
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Telephone | 678-764-8919
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. NANCY YOUNG
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Credential | PMHNP-BC
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Telephone | 678-764-8919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine 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 | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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