Organization
MYSTIC MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA DYKES (ADMIN)
(404) 351-0055
Entity
Organization
Contact information
Practice address
5555 GLENRIDGE CONNECTOR, SUITE 200, ATLANTA, GA 30342-4759
(404) 351-0055
Mailing address
5555 GLENRIDGE CONNECTOR, SUITE 200, ATLANTA, GA 30342-4759
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Enumeration date
03/05/2015
Last updated
03/25/2025
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