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General NPI Number Information
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NPI Number | 1932825783
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Entity Type | Organization
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Legal Business Name | MINDSET WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 10/13/2022
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Last Update Date | 04/12/2025
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Provider Practice Location Address
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Address Line | 1309 COFFEEN AVE STE 1200
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City | SHERIDAN
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State | WY
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Zip | 82801-5777
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Country | US
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Telephone | 470-988-2639
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Fax |
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Provider Business Mailing Address
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Address Line | 5465 HIGHWAY 42 UNIT 246
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City | ELLENWOOD
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State | GA
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Zip | 30294-4042
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Country | US
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Telephone | 470-646-3738
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Fax | 888-910-6463
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Authorized Official
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Title or Position | OWNER
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Name | MS. OMOLOLA OTUBAGA
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Credential |
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Telephone | 470-988-2639
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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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