Brain and Soul Wellness Group, LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

BRAIN AND SOUL WELLNESS GROUP, LLC

Practice address

3050 Five Forks Trickum Rd SW Ste D451
Lilburn, GA 30047-1810

Phone

(214) 280-0848

NPI assigned

Mar 24, 2020

Organization subpart

No

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

Authorized official

Name

Maloa Chu Affuembey, MD

Title

Owner/MD

Phone

(404) 436-0677

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1585008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590364800000",
    "number": "1871120659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 FIVE FORKS TRICKUM RD SW STE D451",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300471810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 FIVE FORKS TRICKUM RD SW STE D451",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300471810",
            "telephone_number": "214-280-0848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAIN AND SOUL WELLNESS GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-24",
        "last_updated": "2020-05-25",
        "certification_date": "2020-05-25",
        "status": "A",
        "authorized_official_last_name": "AFFUEMBEY",
        "authorized_official_first_name": "MALOA",
        "authorized_official_middle_name": "CHU",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "404-436-0677",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana M Boswell, MCD, CCC
• James Brian Boulware, MA, ATC, OTC, LAT
• Yolanda P Bowdre, OTRL
• Marcus Bradley
• Tonya L Brailey
• James Palmer Branch, D.P.M
• William George Brandenburg, DDS
• Braveheart Medical Response LLC
• Karen Bridges, RPH
• Rebecca L Brigola, APNP

• Psychiatry Physician in Lilburn, GA
• Providers in Lilburn, GA by specialty
• Psychiatry Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2020; 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.