Healthcare Provider Details

I. General information

NPI: 1972909810
Provider Name (Legal Business Name): ALISON MIMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 HUNTING RIDGE CIR
ROCK SPRING GA
30739-5022
US

IV. Provider business mailing address

231 HUNTING RIDGE CIR
ROCK SPRING GA
30739-5022
US

V. Phone/Fax

Practice location:
  • Phone: 423-802-0169
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number173545
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-121145
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN19599
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: