Mini-Med Clinic of North Georgia, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MINI-MED CLINIC OF NORTH GEORGIA, LLC

Practice address

5113 Holly Springs Parkway
Canton, GA 30115

Phone

(470) 331-3544

NPI assigned

Aug 4, 2021

Organization subpart

No

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

Authorized official

Name

Ms. Sophia Kennedy, NPNPI 1811418650

Title

Nurse Practitioner

Phone

(678) 398-9697

Specialties & licenses 1

Addresses

Other names 1

• Mini-Med Clinic of North Georgia Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Sophia A Kennedy, FNP

  • Family Nurse Practitioner
  • Canton, GA
  • NPI 1811418650
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1628035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1124792106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5113 HOLLY SPRINGS PARKWAY",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "30115",
            "telephone_number": "678-398-9697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5113 HOLLY SPRINGS PARKWAY",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "30115",
            "telephone_number": "470-331-3544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINI-MED CLINIC OF NORTH GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-04",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "SOPHIA",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "678-398-9697",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mini-Med Clinic of North Georgia",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mini-Med Clinic of North Georgia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Milene Hugo Miller
• Kellye Marie Mills, LPC, NCC
• Jessica Caroline Mimbs, RN, MSN, FNP-C
• Sheila Minder
• Mindful Lactation Education, LLC
• Kimberly Amelia Minick, DC
• Aimee M Mitchell, PHYSICIAN ASSISTANT
• Leah Mitchell
• Tia Marie Mitcheltree
• Crystal Mizell

• Clinic/Center in Canton, GA
• Providers in Canton, GA by specialty
• Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.