Debra J. Mims, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT003220 Issued in GA

Practice address

17 Sadler TRL
Woodbine, GA 31569-3821

Phone

(912) 729-9005

NPI assigned

Dec 26, 2006

Last updated

Feb 2, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612224000000",
    "number": "1265597637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 SADLER TRL",
            "city": "WOODBINE",
            "state": "GA",
            "postal_code": "315693821",
            "telephone_number": "912-729-9005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 SADLER TRL",
            "city": "WOODBINE",
            "state": "GA",
            "postal_code": "315693821",
            "telephone_number": "912-729-9005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIMS",
        "first_name": "DEBRA",
        "middle_name": "J.",
        "name_prefix": "Mrs.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-26",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT003220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "339863",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10058027",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000608979C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "52262717",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tateanna Kozak
• Sabra L. Maddox, RPH
• Mary Lee Carter, MD-PC
• Amanda McNulty
• Jasmine Miller
• On the Path, LLC
• Jodi Palmer, RBT
• Melissa R Perkins, RN
• William Blake Seymour
• Callie Smith

• Physical Therapist in Woodbine, GA
• Providers in Woodbine, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; 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.