Provider Demographics
NPI:1689890626
Name:MIND MATTERS, P.C.
Entity Type:Organization
Organization Name:MIND MATTERS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:D
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-870-8822
Mailing Address - Street 1:6 OFFICE PARK CIR
Mailing Address - Street 2:STE 202
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2512
Mailing Address - Country:US
Mailing Address - Phone:205-870-8822
Mailing Address - Fax:205-871-8394
Practice Address - Street 1:6 OFFICE PARK CIR
Practice Address - Street 2:STE 202
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35223-2512
Practice Address - Country:US
Practice Address - Phone:205-870-8822
Practice Address - Fax:205-871-8394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL148372084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE20873Medicare UPIN
ALS23491Medicare UPIN
ALS11203Medicare UPIN
ALH300Medicare ID - Type Unspecified