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General NPI Number Information
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NPI Number | 1396454138
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Entity Type | Organization
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Legal Business Name | MENTAL WEALTH RESOURCES, LLC
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Dates
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Enumeration Date | 11/21/2022
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Last Update Date | 12/28/2022
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Provider Practice Location Address
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Address Line | 2184 RIVER PARK CT
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City | AUGUSTA
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State | GA
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Zip | 30907-2040
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Country | US
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Telephone | 470-400-7014
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Fax |
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Provider Business Mailing Address
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Address Line | 42 CARRIAGE OAKS DR # 1032
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City | TYRONE
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State | GA
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Zip | 30290-1684
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Country | US
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Telephone | 470-400-7014
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. FRANKLIN EZEH
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Credential | MD
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Telephone | 470-400-7014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health 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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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