MEDICARE: NUMIND WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1053269365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUMIND WELLNESS LLC

Provider Business Mailing Address
First Line	:	725 CANTERBURY RD
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30504-2617
Country	:	US
Telephone Number	:	943-888-7617
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 CANTERBURY RD
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30504-2617
Country	:	US
Telephone Number	:	943-888-7617
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARQUITA LATISHA DAVIS
Credential	:	PMHNP
Telephone Number	:	943-888-7617

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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Directions to “NUMIND WELLNESS LLC ” Practice Location

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