Provider Demographics
NPI:1033231048
Name:MINTZ, MAURIE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURIE
Middle Name:LYNN
Last Name:MINTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SCOTT CIR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4723
Mailing Address - Country:US
Mailing Address - Phone:404-327-8819
Mailing Address - Fax:
Practice Address - Street 1:1328 PEACHTREE ST NE
Practice Address - Street 2:SUITE B317
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3209
Practice Address - Country:US
Practice Address - Phone:404-228-7757
Practice Address - Fax:404-228-7769
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA516902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry