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General NPI Number Information
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NPI Number | 1467092494
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Entity Type | Organization
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Legal Business Name | MIND & ENERGY PSYCHIATRY, LLC
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 03/24/2021
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Provider Practice Location Address
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Address Line | 37 CALUMET PKWY BLDG F STE 201
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City | NEWNAN
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State | GA
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Zip | 30263-6734
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Country | US
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Telephone | 678-628-7156
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Fax |
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Provider Business Mailing Address
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Address Line | 37 CALUMET PKWY BLDG F STE 201
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City | NEWNAN
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State | GA
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Zip | 30263
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Country | US
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Telephone | 770-683-4538
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TAYANAU NUNEZ
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Credential |
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Telephone | 770-683-4538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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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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