Provider Demographics
NPI:1699491852
Name:MINDWELL LLC
Entity type:Organization
Organization Name:MINDWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAROD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-735-8080
Mailing Address - Street 1:16 MILLS AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 MILLS AVE STE 6
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4065
Practice Address - Country:US
Practice Address - Phone:864-735-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty