Individual provider Active NPI

Mirianda Ndaptso

  • Psychiatric/Mental Health Nurse Practitioner
  • Marietta, GA
National Provider Identifier
1205429941
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
GAA-NPO00690 Issued in GA
Practice address
3008 Edgefield Dr SW
Marietta, GA 30008-7665
Phone
(678) 497-5145
NPI assigned
Feb 13, 2021
Last updated
Jul 23, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X GAA-NPO00690 GA
Community Health Nurse Practitioner 363LC1500X GAA-NPO00690 GA
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X GAA-NPO00690 GA Primary

Addresses

Primary practice location

3008 Edgefield Dr SW
Marietta, GA 30008-7665

Mailing address

3008 Edgefield Dr SW
Marietta, GA 30008-7665
Phone (678) 497-5145

Other practice location 1

265 S Elm St
Commerce, GA 30529-3294
Phone (678) 497-5145

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221005001918 GA Practitioner - Nurse Practitioner 2769885201 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
GAA-NPO00690GAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mymira Healthcare Services LLC CurrentSince Sep 4, 2022 Accepting new patients
Mental Health Specialty Group PA Multi-Specialty CurrentSince Oct 1, 2025 Accepting new patients

Locations

3424 Peachtree Rd NE
Ste 2200
Atlanta, GA 30326
Phone (404) 436-2563

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1613174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1205429941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3008 EDGEFIELD DR SW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300087665",
            "telephone_number": "678-497-5145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3008 EDGEFIELD DR SW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300087665",
            "telephone_number": "678-497-5145"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "265 S Elm St",
            "address_purpose": "LOCATION",
            "city": "Commerce",
            "state": "GA",
            "postal_code": "305293294",
            "country_code": "US",
            "telephone_number": "678-497-5145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NDAPTSO",
        "first_name": "MIRIANDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-13",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "GAA-NPO00690",
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "GA",
            "license": "GAA-NPO00690",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "GAA-NPO00690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.