Healthcare Provider Details

I. General information

NPI: 1962311423
Provider Name (Legal Business Name): MIRACLES START HERE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 LOWER CREEK PASS
MCDONOUGH GA
30252-7508
US

IV. Provider business mailing address

2700 CUMBERLAND PKWY SE
ATLANTA GA
30339-3321
US

V. Phone/Fax

Practice location:
  • Phone: 470-502-7875
  • Fax:
Mailing address:
  • Phone: 470-502-7875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MIKIYAMA CLEVELAND
Title or Position: CEO
Credential:
Phone: 470-502-7875