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General NPI Number Information
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NPI Number | 1366155947
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Entity Type | Organization
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Legal Business Name | ELEVATED MENTAL HEALTH AND WELLNESS CENTER
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Dates
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Enumeration Date | 12/28/2022
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Last Update Date | 12/28/2022
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Provider Practice Location Address
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Address Line | 1302 POINTCREST LN
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City | GRAYSON
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State | GA
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Zip | 30017-4293
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Country | US
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Telephone | 470-238-9321
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 SPOUT SPRINGS RD STE 3C
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-6449
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Country | US
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Telephone | 470-238-9321
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Fax |
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Authorized Official
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Title or Position | APRN
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Name | JERE COOPER
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Credential | APRN
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Telephone | 678-467-8232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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