Individual provider Active NPI

Alyssa Bantz Hindmon, CNM

  • Midwife
  • Atlanta, GA
National Provider Identifier
1417477472
Registry record updated Oct 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
MidwifeTaxonomy code 176B00000X
License
RN233925 Issued in GA
Practice address
4805 Tilly Mill Rd
Atlanta, GA 30360-1909
Phone
(470) 552-9009
NPI assigned
Jun 21, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Midwife 176B00000X RN233925 GA Primary

Addresses

Primary practice location

4805 Tilly Mill Rd
Atlanta, GA 30360-1909

Mailing address

3039 Scott Rd
Marietta, GA 30066-3701
Phone (772) 828-1647

Other names 1

  • Ms. Alyssa Bantz Former name

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
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
RN233925GAMDMidwife

NPI Registry JSON

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

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635120000000",
    "number": "1417477472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3039 SCOTT RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300663701",
            "telephone_number": "772-828-1647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4805 TILLY MILL RD",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303601909",
            "telephone_number": "470-552-9009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HINDMON",
        "first_name": "ALYSSA",
        "middle_name": "BANTZ",
        "name_prefix": "Mrs.",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-21",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "GA",
            "license": "RN233925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALYSSA",
            "last_name": "BANTZ",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.