Shannon Davy Mimbs, MACMHC, MDIV

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

304 Arlington Dr
Vidalia, GA 30474-8935

Phone

(912) 805-9255

NPI assigned

Jul 23, 2021

Last updated

Jan 24, 2022By the provider in NPPES

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)

Not enrolled

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

{
    "created_epoch": "1626998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642982400000",
    "number": "1598338808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 ARLINGTON DR",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304748935",
            "telephone_number": "912-231-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 ARLINGTON DR",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304748935",
            "telephone_number": "912-805-9255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIMBS",
        "first_name": "SHANNON",
        "middle_name": "DAVY",
        "credential": "MACMHC, MDIV",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-23",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susanna Meredith, M.D.
• Middle Georgia DME Company
• Marla Kristen Mikell, FNP-C
• Janice Miller
• Lauren Courtney Miller, M.D.
• Mary Minter, NP-C
• Misty D. Poole, MD, LLC (Vidalia Internal Medicine)
• Dianne S Mixon, PA-C
• Christine Mobley
• Molly M. Kramer M.D.,P.C.

• Professional Counselor in Vidalia, GA
• Providers in Vidalia, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; 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.