Provider Demographics
NPI:1760947204
Name:MENTAL HEALTH SOLUTION TO WELLNESS PC
Entity Type:Organization
Organization Name:MENTAL HEALTH SOLUTION TO WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TYRONJALA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINEY-GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-925-5065
Mailing Address - Street 1:274 RUGGED CREEK DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4567
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:950 EAGLES LANDING PKWY # 651
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7343
Practice Address - Country:US
Practice Address - Phone:770-925-5065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty