Provider Demographics
NPI:1437761566
Name:MUSCOGEE MENTAL HEALTH AND WELLNESS SERVICES LLC
Entity Type:Organization
Organization Name:MUSCOGEE MENTAL HEALTH AND WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRSATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:334-560-4132
Mailing Address - Street 1:9111 WHITE BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4606
Mailing Address - Country:US
Mailing Address - Phone:921-483-4490
Mailing Address - Fax:
Practice Address - Street 1:9111 WHITE BLUFF RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4606
Practice Address - Country:US
Practice Address - Phone:334-560-4132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty