Mimi Kim Song, MSN, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

RN213220 Issued in GA

Practice address

10692 Medlock Bridge Rd Ste 100a
Johns Creek, GA 30097-8497

Phone

(404) 446-2496

NPI assigned

Jul 15, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife, Master of Science - Nursing

State licenses

Practice roles

Locations

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.

• Modern Obstetrics and Gynecology of North Atlanta PC

  • Obstetrics & Gynecology Physician
  • Johns Creek, GA
  • NPI 1669784252

  Obstetrics & Gynecology

  NPD
• North Perimeter Anesthesia LLC

  • Anesthesiology Physician
  • Atlanta, GA
  • NPI 1457716516
  NPD (past)

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

{
    "created_epoch": "1500076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613520000000",
    "number": "1609398155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 STONEHILL DR",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300419305",
            "telephone_number": "678-793-0089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10692 MEDLOCK BRIDGE RD STE 100A",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300978497",
            "telephone_number": "404-446-2496"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "699 Church St NE Ste 300",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300601122",
            "country_code": "US",
            "telephone_number": "770-422-8700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SONG",
        "first_name": "MIMI",
        "middle_name": "KIM",
        "credential": "MSN, CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-15",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "RN213220",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "GA",
            "license": "RN213220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mimisongcnm@reyesobygn.com",
            "affiliation": "N",
            "address_1": "10692 Medlock Bridge Rd Ste 100A",
            "city": "Johns Creek",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300978497",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dorothy Firth Smith, MA, LPC
• Jeffrey Percey Smith Jr., M.D.
• Eunice Sok, PA-C
• Joselyn Solis
• Viorika Soltanovich, CPO
• Lorri R. South, CRNA
• Southern Sky Outpatient Detox, LLC
• Nicole A Sparks, M.D.
• Special Transition Works , LLC
• Jay Erin Spector, DPM

• All providers in Johns Creek, GA
• Advanced Practice Midwife in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.