Green Mind Behavioral Health Services LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

GREEN MIND BEHAVIORAL HEALTH SERVICES LLC

Practice address

5385 Five Forks Trickum Rd
Stone Mountain, GA 30087-3018

Phone

(770) 766-3003

Fax

(770) 599-5966

NPI assigned

Nov 2, 2024

Last updated

Dec 19, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Aisha AdigunNPI 1861271975

Title

Pmhnp-BC

Phone

(770) 766-3003

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Aisha Adigun

  • Psychiatric/Mental Health Nurse Practitioner
  • Stone Mountain, GA
  • NPI 1861271975
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734566400000",
    "number": "1396568911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5385 FIVE FORKS TRICKUM RD STE F",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873018",
            "telephone_number": "770-766-3003",
            "fax_number": "770-599-5966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5385 FIVE FORKS TRICKUM RD",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873018",
            "telephone_number": "770-766-3003",
            "fax_number": "770-599-5966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN MIND BEHAVIORAL HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-02",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A",
        "authorized_official_last_name": "ADIGUN",
        "authorized_official_first_name": "AISHA",
        "authorized_official_title_or_position": "PMHNP-BC",
        "authorized_official_telephone_number": "770-766-3003"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.