A Beautiful Mind Psychiatry
Organization Active NPI Psychiatry Physician · Commerce, GA
NPI 1861266397 · NPPES record last updated Apr 16, 2024
Key facts
- NPI
- 1861266397
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- A BEAUTIFUL MIND PSYCHIATRY
- Practice address
- 1732 N Broad St
Commerce, GA 30529-1903 - Phone
- (706) 449-2884
- NPI assigned
- Nov 15, 2023
- Organization subpart
- No
Authorized official
- Name
- Dr. Charmaine Wilson, MD
- Title
- Owner
- Phone
- (706) 449-2884
Practitioners 3
-
Kecia Marshall Berry, PMHNP-BC
-
Charmaine Wilson, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240718004351 | GA | Part B Supplier - Clinic/Group Practice | 0840736435 |
Receives reassigned benefits from 1 practitioner Practice locations: Riverdale, GA |
National Provider Directory
Locations
4485 Fulton Industrial Blvd SW
Ste A1
Atlanta, GA 30336
Phone (470) 914-6244
4395 Fulton Industrial Blvd SW
Ste D
Atlanta, GA 30336
Phone (404) 500-0129
154 Valley Hill Rd SW
Ste D
Riverdale, GA 30274
Phone (706) 449-2884
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | Yes |
Addresses
Primary practice location
1732 N Broad St
Commerce, GA 30529-1903
Mailing address
4395 Fulton Industrial Blvd SW Ste D
Atlanta, GA 30336-1955
Phone (706) 449-2884
Other providers in Commerce, GA
- 416 Physical Therapy LLC
- Don L Abernethy Jr.
- Mary Allison Adams
- Robyne Levale Adams
- Advantage BHS
- Affordable Dentures - Commerce,P.C.
All providers in Commerce, GA · Psychiatry Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.