Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 033152 | GA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 033152 | GA |
NPI | 1194828541 |
---|---|
Provider Name | Adrienne D Mims |
First Address | Miami Gardens, FL 33169-5710 |
Second Address | Morrow, GA 30260-2357 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 24/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E32587 | (02) |