Active NPI
Addison Brynne Mienert
- Athletic Trainer
- Cumming, GA
National Provider Identifier
1811549819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 058916984
- Practice address
- 6450 Ivey Manor Dr
Cumming, GA 30040-6684 - Phone
- (770) 878-7660
- NPI assigned
- Jul 10, 2019
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 058916984 | GA | Primary |
Addresses
Primary practice location
6450 Ivey Manor Dr
Cumming, GA 30040-6684
Mailing address
6450 Ivey Manor Dr
Cumming, GA 30040-6684
Phone (770) 878-7660
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 |
|---|---|---|---|
| 058916984 | GA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562716800000",
"number": "1811549819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6450 IVEY MANOR DR",
"city": "CUMMING",
"state": "GA",
"postal_code": "300406684",
"telephone_number": "770-878-7660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6450 IVEY MANOR DR",
"city": "CUMMING",
"state": "GA",
"postal_code": "300406684",
"telephone_number": "770-878-7660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIENERT",
"first_name": "ADDISON",
"middle_name": "BRYNNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-07-10",
"last_updated": "2019-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "GA",
"license": "058916984",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cumming, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.