| Empowered Minds Behavioral | |
|
12461 Veterans Memorial Hwy Ste 805 Douglasville GA 30134-2025 | |
| (404) 595-8722 | |
| (678) 737-1432 |
| Full Name | Empowered Minds Behavioral |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 12461 Veterans Memorial Hwy Ste 805, Douglasville, Georgia |
| Authorized Official Name and Position | Shialla Deneen Warren (NURSE PRACTITIONER) |
| Authorized Official Contact | 4045958722 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Empowered Minds Behavioral 12461 Veterans Memorial Hwy Ste 805 Douglasville GA 30134-2025 Ph: (404) 595-8722 | Empowered Minds Behavioral 12461 Veterans Memorial Hwy Ste 805 Douglasville GA 30134-2025 Ph: (404) 595-8722 |
| NPI Number | 1427787720 |
|---|---|
| Provider Enumeration Date | 06/10/2022 |
| Last Update Date | 06/20/2024 |
| Certification Date | 06/20/2024 |
| Medicare PECOS PAC ID | 3678019973 |
|---|---|
| Medicare Enrollment ID | O20240723002488 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427787720 | NPI | - | NPPES |
| Provider Name | Shialla Deneen Warren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962078089 PECOS PAC ID: 3476954470 Enrollment ID: I20210629000343 |
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