Olubansile A Mimiko, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

050663 Issued in GA

Practice address

521 Griffin Ave
Eastman, GA 31023-6712

Phone

(478) 374-4128

NPI assigned

Oct 13, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
• FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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

• Georgia Department of Human Resources

  • Psychiatric Hospital
  • Columbus, GA
  • NPI 1144224767
  NPD (past)
• Ogeechee Behavioral Health Services

  • Community/Behavioral Health Agency
  • Swainsboro, GA
  • NPI 1952451262
  NPD (past)
• Trustees of Columbia University in the City of New York

  • Internal Medicine Physician
  • New York, NY
  • NPI 1699289488
  NPD (past)

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1336239177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 4128",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310234128",
            "telephone_number": "478-374-2742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 GRIFFIN AVE",
            "city": "EASTMAN",
            "state": "GA",
            "postal_code": "310236712",
            "telephone_number": "478-374-4128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIMIKO",
        "first_name": "OLUBANSILE",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "050663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Middle Georgia Nursing Home, Inc.
• Middle Georgia Sleep & Wellness Center, LLC
• Middle Georgia Total Health Center, LLC
• Bart Steele Milner, P.A.
• Blake E Milner, M.D.
• Demetria Aries Mitchell
• Dana W Mullis, DMD
• Debbie Jones Mullis, LCSW
• James Michael Mullis
• Ocmulgee Family Medicine LLC.

• Specialist in Eastman, GA
• Providers in Eastman, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.