| Mindy Jewett, Llc | |
|
2060 Longview Way Atlanta GA 30341-1512 | |
| (678) 333-6311 | |
| Not Available |
| Full Name | Mindy Jewett, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2060 Longview Way, Atlanta, Georgia |
| Authorized Official Name and Position | Gayle R Andrus (ORGANIZER) |
| Authorized Official Contact | 7706383222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindy Jewett, Llc 2060 Longview Way Atlanta GA 30341-1512 Ph: (678) 333-6311 | Mindy Jewett, Llc 2060 Longview Way Atlanta GA 30341-1512 Ph: (678) 333-6311 |
| NPI Number | 1992994172 |
|---|---|
| Provider Enumeration Date | 10/23/2007 |
| Last Update Date | 10/23/2007 |
| Medicare PECOS PAC ID | 7012007057 |
|---|---|
| Medicare Enrollment ID | O20071214000309 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992994172 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 003045 (Georgia) | Primary |
| Provider Name | Mindy B Jewett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477684025 PECOS PAC ID: 7618072190 Enrollment ID: I20070411000171 |
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