Jackson Keith Mize, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT003505 Issued in GA

Practice address

590 Cobb Avenue MD #0201
Kennesaw, GA 30144

Phone

(470) 578-2786

NPI assigned

Jul 10, 2023

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

State licenses

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

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1881372829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3091 COBB PKWY NW APT 1334",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301528000",
            "telephone_number": "256-509-5364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 COBB AVENUE MD #0201",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "30144",
            "telephone_number": "470-578-2786"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 George Busbee Pkwy NW",
            "address_purpose": "LOCATION",
            "city": "Kennesaw",
            "state": "GA",
            "postal_code": "301444999",
            "country_code": "US",
            "telephone_number": "256-509-5364",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIZE",
        "first_name": "JACKSON",
        "middle_name": "KEITH",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT003505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fianna Mischel
• Anna Mistretta-Bradley, LPC
• Briana Leggett Mitchell, M.A.
• Joy Mitchell
• Melodie Jeanine Mitchell, D.C.
• Rebecca Mize, OTRL
• MMKG Counseling Services LLC
• Ambareen Mohamed, O.D.
• Nadia Mohammed, PA
• Diana Molina Maltez

• Athletic Trainer in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Athletic Trainer in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; 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.