| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 03/11/2021 |
| Last Update Date | 12/30/2021 |
| Certification Date | 12/30/2021 |
| Medicare PECOS PAC ID | 2365859915 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245794387 PECOS PAC ID: 1456786912 Enrollment ID: I20200111000041 |
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