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General NPI Number Information
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NPI Number | 1699408005
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Entity Type | Organization
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Legal Business Name | GROWTH MINDSET WELLNESS PC
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Dates
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Enumeration Date | 07/04/2022
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 175 CORPORATE CENTER DR STE B
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7382
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Country | US
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Telephone | 470-275-2358
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Fax |
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Provider Business Mailing Address
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Address Line | 175 CORPORATE CENTER DR STE B
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7382
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Country | US
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Telephone | 470-275-2358
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Fax | 470-319-6353
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Authorized Official
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Title or Position | OWNER
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Name | MS. TIFFANY BATES
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Credential | APRN
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Telephone | 470-275-2358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult 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 | 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 #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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