Mindset Healthcare, Pc | |
135 Bradford Sq Ste B Fayetteville GA 30215-1902 | |
(470) 646-3738 | |
(888) 910-6463 |
Full Name | Mindset Healthcare, Pc |
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Speciality | Nurse Practitioner |
Location | 135 Bradford Sq Ste B, Fayetteville, Georgia |
Authorized Official Name and Position | Omolola A Otubaga (APRN-BC/NURSE PRACTIONER) |
Authorized Official Contact | 4044441904 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Mindset Healthcare, Pc 5465 Highway 42 Unit 246 Ellenwood GA 30294-4042 Ph: (470) 646-3738 | Mindset Healthcare, Pc 135 Bradford Sq Ste B Fayetteville GA 30215-1902 Ph: (470) 646-3738 |
NPI Number | 1285119925 |
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Provider Enumeration Date | 09/28/2018 |
Last Update Date | 04/25/2023 |
Certification Date | 04/25/2023 |
Medicare PECOS PAC ID | 0547514606 |
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Medicare Enrollment ID | O20181108002691 |
Identifier | Type | State | Issuer |
---|---|---|---|
1285119925 | NPI | - | NPPES |
Provider Name | Douglas Cooper |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1255495131 PECOS PAC ID: 2062303498 Enrollment ID: I20110509000721 |
Provider Name | Omolola Otubaga |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033595566 PECOS PAC ID: 3779863188 Enrollment ID: I20161130002356 |
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