Beautiful Minds Of Fayetteville Llc | |
220 Sycamore Bnd Fayetteville GA 30214-1201 | |
(678) 590-1232 | |
(470) 381-1502 |
Full Name | Beautiful Minds Of Fayetteville Llc |
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Speciality | Psychiatry & Neurology |
Location | 220 Sycamore Bnd, Fayetteville, Georgia |
Authorized Official Name and Position | Stacey Lasandra Mitchell (OWNER) |
Authorized Official Contact | 6785901232 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Beautiful Minds Of Fayetteville Llc 1415 Highway 85 N Ste 310-390 Fayetteville GA 30214-7738 Ph: (678) 590-1232 | Beautiful Minds Of Fayetteville Llc 220 Sycamore Bnd Fayetteville GA 30214-1201 Ph: (678) 590-1232 |
NPI Number | 1134704125 |
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Provider Enumeration Date | 03/11/2021 |
Last Update Date | 12/30/2021 |
Certification Date | 12/30/2021 |
Medicare PECOS PAC ID | 2365859915 |
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Medicare Enrollment ID | O20210325002407 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134704125 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
Provider Name | Stacey Mitchell |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1245794387 PECOS PAC ID: 1456786912 Enrollment ID: I20200111000041 |
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