Active NPI
Miriam Jennings
- Specialist
- Hephzibah, GA
National Provider Identifier
1902524234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- CO104681
- Practice address
- 2763 Tobacco Rd Ste E-2
Hephzibah, GA 30815-7050 - Phone
- (706) 726-5406
- NPI assigned
- Aug 22, 2022
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | CO104681 | GA | Primary |
Addresses
Primary practice location
2763 Tobacco Rd Ste E-2
Hephzibah, GA 30815-7050
Mailing address
2714 Deen Ave
Augusta, GA 30906-3232
Phone (706) 726-5406
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 |
|---|---|---|---|
| CO104681 | GA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wyld Lillies Crown | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Durable Medical Equipment & Medical Supplies
- Hephzibah, GA
- NPI 1649965286
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661126400000",
"number": "1902524234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2714 DEEN AVE",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309063232",
"telephone_number": "706-726-5406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2763 TOBACCO RD STE E-2",
"city": "HEPHZIBAH",
"state": "GA",
"postal_code": "308157050",
"telephone_number": "706-726-5406"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENNINGS",
"first_name": "MIRIAM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-08-22",
"last_updated": "2022-08-22",
"certification_date": "2022-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "GA",
"license": "CO104681",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hephzibah, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.