| Mindset Healthcare, Pc | |
|
135 Bradford Sq Ste B Fayetteville GA 30215-1902 | |
| (470) 646-3738 | |
| (888) 910-6463 |
| Full Name | Mindset Healthcare, Pc |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 09/28/2018 |
| Last Update Date | 04/25/2023 |
| Certification Date | 04/25/2023 |
| Medicare PECOS PAC ID | 0547514606 |
|---|---|
| Medicare Enrollment ID | O20181108002691 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285119925 | NPI | - | NPPES |
| Provider Name | Douglas Cooper |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255495131 PECOS PAC ID: 2062303498 Enrollment ID: I20110509000721 |
| Provider Name | Omolola Otubaga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033595566 PECOS PAC ID: 3779863188 Enrollment ID: I20161130002356 |
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