MEDICARE: MINDSPRING HEALTH INC.

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1508501206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDSPRING HEALTH INC.

Provider Business Mailing Address
First Line	:	1209 THORNCLIFF CT
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-8139
Country	:	US
Telephone Number	:	404-618-1854
Fax Number	:

Provider Business Practice Location Address
First Line	:	1074 PONCE DE LEON AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-4216
Country	:	US
Telephone Number	:	404-618-1854
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. AHMAD UMAIR JANJUA
Credential	:	MD
Telephone Number	:	404-618-1854

Provider Enumeration Date	:	04/28/2022
Last Update Date	:	01/12/2023

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