# MINDSET HEALTHCARE, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285119925
- **Authorized official:** OMOLOLA A OTUBAGA (APRN-BC/NURSE PRACTIONER)
- **Authorized official phone:** (404) 444-1904

## Contact information

- **Practice address:** 135 BRADFORD SQ STE B, FAYETTEVILLE, GA 30215-1902
- **Practice address phone:** (470) 646-3738
- **Practice address fax:** (888) 910-6463
- **Mailing address:** 5465 HIGHWAY 42 UNIT 246, ELLENWOOD, GA 30294-4042
- **Mailing address phone:** (470) 646-3738
- **Mailing address fax:** (888) 910-6463

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 291U00000X | Clinical Medical Laboratory | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/28/2018
- **Last updated:** 04/25/2023