Provider Demographics
NPI:1285119925
Name:MINDSET HEALTHCARE, PC
Entity type:Organization
Organization Name:MINDSET HEALTHCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN-BC/NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:OMOLOLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:OTUBAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-444-1904
Mailing Address - Street 1:5465 HIGHWAY 42 UNIT 246
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-4042
Mailing Address - Country:US
Mailing Address - Phone:470-646-3738
Mailing Address - Fax:888-910-6463
Practice Address - Street 1:135 BRADFORD SQ STE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-1902
Practice Address - Country:US
Practice Address - Phone:470-646-3738
Practice Address - Fax:888-910-6463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty