MEDICARE: ALPHA MIND VENTURES 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1871436600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA MIND VENTURES INC

Provider Business Mailing Address
First Line	:	2302 PARKLAKE DR NE STE 146
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2302 PARKLAKE DR NE STE 146
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2956
Country	:	US
Telephone Number	:	404-855-4858
Fax Number	:

Authorized Official
Title or Position	:	LAB DIRECTOR
Name	:	DEJA BUSH
Credential	:
Telephone Number	:	404-855-4858

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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