MEDICARE: PEACEFUL MYNDZ INTEGRATED CARE, 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	:	1740138932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACEFUL MYNDZ INTEGRATED CARE, LLC

Provider Business Mailing Address
First Line	:	2694 FAIRLANE DR SE APT 1
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30354-2122
Country	:	US
Telephone Number	:	586-770-3512
Fax Number	:

Provider Business Practice Location Address
First Line	:	2694 FAIRLANE DR SE APT 1
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30354-2122
Country	:	US
Telephone Number	:	586-770-3512
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LATANYA DENISE MILLER
Credential	:	PMHNP-BC
Telephone Number	:	586-770-3512

Provider Enumeration Date	:	03/21/2026
Last Update Date	:	03/21/2026

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