Active NPI
Tessa Ree Mingo
- Prosthetist
- Locust Grove, GA
National Provider Identifier
1376207969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetist
- License
- C0138190
- Practice address
- 4912 Bill Gardner Parkway
Locust Grove, GA 30248-3025 - Phone
- (662) 542-4644
- NPI assigned
- Oct 28, 2021
- Last updated
- Oct 28, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetist | 224P00000X | C0138190 | GA | Primary |
Addresses
Primary practice location
4912 Bill Gardner Parkway
Locust Grove, GA 30248-3025
Mailing address
2030 Towne Park Dr
McDonough, GA 30252
Phone (662) 542-4464
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C0138190 | GA | MD | Prosthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1635379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635379200000",
"number": "1376207969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2030 TOWNE PARK DR",
"city": "MCDONOUGH",
"state": "GA",
"postal_code": "30252",
"telephone_number": "662-542-4464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4912 BILL GARDNER PARKWAY",
"city": "LOCUST GROVE",
"state": "GA",
"postal_code": "302483025",
"telephone_number": "662-542-4644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINGO",
"first_name": "TESSA",
"middle_name": "REE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-10-28",
"last_updated": "2021-10-28",
"certification_date": "2021-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "224P00000X",
"taxonomy_group": "",
"desc": "Prosthetist",
"state": "GA",
"license": "C0138190",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Locust Grove, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.