Jake Ryan Mimms, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6432 Issued in AL

Practice address

8263 Madison Blvd Ste a
Madison, AL 35758-2051

Phone

(256) 774-7228

NPI assigned

Mar 28, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563321600000",
    "number": "1700318060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8263 MADISON BLVD STE A",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357582051",
            "telephone_number": "256-774-7228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8263 MADISON BLVD STE A",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357582051",
            "telephone_number": "256-774-7228"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "875 Union Ave",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381033513",
            "country_code": "US",
            "telephone_number": "901-448-2242",
            "fax_number": "901-448-1294",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIMMS",
        "first_name": "JAKE",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-28",
        "last_updated": "2019-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "6432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sam Idongesit Michael, MD
• Kimberly W Miller, M.D.
• Megan Miller, RBT
• Tracy Miller, LMSW
• Ryan Mills
• Robert Mims, PA-C
• Mind & Body Family Practice and Behavioral Health, LLC
• Mind Over Matter Mental Health, LLC
• Mind Your Journey Counseling Services, LLC
• Mindful River Counseling LLC

• General Practice Dentistry in Madison, AL
• Providers in Madison, AL by specialty
• General Practice Dentistry in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2019; 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.