Provider Demographics
NPI:1063391274
Name:MEDICAL & MENTAL HOLISTIC HEALTHCARE
Entity type:Organization
Organization Name:MEDICAL & MENTAL HOLISTIC HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY CARE NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:N
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:AGNP-C, PMHNP-C
Authorized Official - Phone:678-599-3670
Mailing Address - Street 1:7544 SOUTHLAKE PKWY STE 102B
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2495
Mailing Address - Country:US
Mailing Address - Phone:770-240-4849
Mailing Address - Fax:678-737-1743
Practice Address - Street 1:7544 SOUTHLAKE PKWY STE 102B
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2495
Practice Address - Country:US
Practice Address - Phone:770-240-4849
Practice Address - Fax:678-737-1743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty