NPIMap

Organization Active NPI

Un Simple Minded

  • Community Health Worker
  • Lawrenceville, GA
National Provider Identifier
1003567223
Registry record updated Jan 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
Legal business name
UN SIMPLE MINDED
Practice address
810 Eagle Cove Way
Lawrenceville, GA 30044-5843
Phone
(678) 975-5539
NPI assigned
Jan 11, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2022

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

Authorized official

Name
Amir Bernard LaneNPI 1386305621
Title
Owner
Phone
(678) 975-5539

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 172V00000X Primary

Addresses

Primary practice location

810 Eagle Cove Way
Lawrenceville, GA 30044-5843

Mailing address

810 Eagle Cove Way
Lawrenceville, GA 30044-5843
Phone (678) 975-5539

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1641859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641859200000",
    "number": "1003567223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 EAGLE COVE WAY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300445843",
            "telephone_number": "678-975-5539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 EAGLE COVE WAY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300445843",
            "telephone_number": "678-975-5539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UN SIMPLE MINDED",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-11",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "AMIR",
        "authorized_official_middle_name": "BERNARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-975-5539"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2022; 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.