Micromed LLC

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

Legal business name

MICROMED LLC

Practice address

1266 W Paces Ferry Rd NW Ste 231
Atlanta, GA 30327-2306

Phone

(917) 991-0319

NPI assigned

Feb 25, 2020

Organization subpart

No

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

Authorized official

Name

Theresa Wang

Title

President

Phone

(917) 991-0319

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1582588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582588800000",
    "number": "1104450402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1266 W PACES FERRY RD NW STE 231",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303272306",
            "telephone_number": "917-991-0319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1266 W PACES FERRY RD NW STE 231",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303272306",
            "telephone_number": "917-991-0319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICROMED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-25",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A",
        "authorized_official_last_name": "WANG",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "917-991-0319"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Geoffrey Edward Mickells, M.D.
• Samuel A Mickelson, MD
• Jadella Amanda Mickler, AGACNP-BC
• Jamaya Mickles
• Jeannel Tan Miclat
• Mid Physician Network (in), LLC
• Mid Physician Network (in), LLC
• Mid Physician Network (Ky), LLC
• Mid Physician Network (Ky), LLC
• Mid Physician Network (Oh), LLC

• Plastic and Reconstructive Surgery Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Plastic and Reconstructive Surgery Physician in Georgia

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