Mims Care Home

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

060-01-360-9 Issued in GA

Legal business name

MIMS CARE HOME

Practice address

1589 Mims St SW
Atlanta, GA 30314-2255

Phone

(404) 569-1041

NPI assigned

Jul 24, 2009

Last updated

Jul 24, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Olubisi Emmanuel Oluyemi, PH.D

Title

C.E.O

Phone

(404) 569-1041

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1248393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248393600000",
    "number": "1952531956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 JOCKEY HOLLOW DR NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301523169",
            "telephone_number": "404-569-1041",
            "fax_number": "770-422-5929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1589 MIMS ST SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303142255",
            "telephone_number": "404-569-1041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIMS CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-24",
        "last_updated": "2009-07-24",
        "status": "A",
        "authorized_official_last_name": "OLUYEMI",
        "authorized_official_first_name": "OLUBISI",
        "authorized_official_middle_name": "EMMANUEL",
        "authorized_official_title_or_position": "C.E.O",
        "authorized_official_telephone_number": "404-569-1041",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "GA",
            "license": "060-01-360-9",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "GA",
            "license": "060-01-360-9",
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": "060-01-360-9",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandi Nichole Milton, NP-C
• Samuel Byron Milton III, MD
• Vashawn Milton
• Danielle Miltz, PA-C
• Brenda-Ruth Nissan Mimba
• Billy Gene Mims-Goodman, CRNA
• Austyn Mims
• Ayana J Mims
• Daja Mims
• Jah Von Anthony Mims

• Assisted Living Facility in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Assisted Living Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2009; 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.