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General NPI Number Information
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NPI Number | 1790605822
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Entity Type | Organization
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Legal Business Name | BRAVE MINDS WELLNESS, LLC
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Dates
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Enumeration Date | 07/18/2026
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Last Update Date | 08/06/2026
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Provider Practice Location Address
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Address Line | 354 NEWNAN CROSSING BYP FL 2
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City | NEWNAN
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State | GA
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Zip | 30265-2323
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Country | US
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Telephone | 470-995-5469
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Fax | 406-289-9609
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Provider Business Mailing Address
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Address Line | 354 NEWNAN CROSSING BYP STE 235
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City | NEWNAN
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State | GA
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Zip | 30265-2435
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Country | US
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Telephone | 470-995-5469
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Fax | 406-289-9609
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Authorized Official
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Title or Position | OWNER
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Name | DORTHEA ROGERS
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Credential | APRN
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Telephone | 470-995-5469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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