Healthcare Provider Details

I. General information

NPI: 1447164116
Provider Name (Legal Business Name): CAROLYN S MIMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 MABLETON PKWY SW STE 201
MABLETON GA
30126-3364
US

IV. Provider business mailing address

5701 MABLETON PKWY SW STE 201
MABLETON GA
30126-3364
US

V. Phone/Fax

Practice location:
  • Phone: 678-743-6888
  • Fax: 404-779-0029
Mailing address:
  • Phone: 678-743-6888
  • Fax: 404-779-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: