MR. GREGORY S MIMS II (NPI# 1629064910) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629064910 |
| Entity Type | Individual |
| Full Name | MR. GREGORY S MIMS II |
| Credential | MD |
| Practice Address |
13833 Tapia Ave Bayou La Batre AL 36509-2515 |
| Mailing Address |
492 Sunset Beach Rd Morgantown WV 26508-4424 |
| Practice Telephone | 2518244985 |
| Mailing Telephone | 5413311225 |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2015-01-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | MD.29861 | AL | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 23477 | WV | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | MD069739L | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | DEA | BM6805937 | 01 |
| Street Address |
13833 TAPIA AVE |
| City | BAYOU LA BATRE |
| State | AL |
| Zip Code | 36509-2515 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437776598 | Karen J Faulk | Social Worker | 13833 Tapia Ave, Bayou La Batre, AL 36509-2515 | 2020-07-06 |
| 1972083012 | Altapointe Health Systems, Inc | Clinic/Center | 13833 Tapia Ave, Bayou La Batre, AL 36509 | 2018-08-17 |
| 1295212363 | Accordia Health, Inc. | Family Medicine | 13833 Tapia Ave, Bayou La Batre, AL 36509-2515 | 2018-07-23 |
| 1598121816 | Alyson Nicole Buckley | Nurse Practitioner | 13833 Tapia Ave, Bayou La Batre, AL 36509 | 2016-01-04 |
| 1629444583 | Samantha N Pettaway | Social Worker | 13833 Tapia Ave, Bayou La Batre, AL 36509-2515 | 2015-08-14 |
| 1609251560 | Earnestine Williams | Nurse Practitioner | 13833 Tapia Ave, Bayou La Batre, AL 36509-2515 | 2015-07-21 |
| 1033504428 | Ashlen Aggen | Family Medicine | 13833 Tapia Ave, Bayou La Batre, AL 36509-2515 | 2015-04-01 |
| 1427157254 | Juanita C Villasis-lopez | Internal Medicine | 13833 Tapia Ave, Bayou La Batre, AL 36509-2515 | 2006-09-21 |
| 1033188339 | Regina M Benjamin | Family Medicine | 13833 Tapia Ave, Bayou La Batre, AL 36509-2515 | 2006-03-17 |
| 1114996865 | Bayouclinic, Inc. | Family Medicine | 13833 Tapia Ave, Bayou La Batre, AL 36509-2515 | 2006-03-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952610974 | Erin Nicole Canady | Physician Assistant | 13833 Tapia Lane, Bayou La Batre, AL 36509 | 2010-09-27 |
| 1649375478 | Alabama Cvs Pharmacy, L.L.C. | Pharmacy | 12900 Nwintzell Ave, Bayou Labatre, AL 36509 | 2006-09-14 |
| 1194770669 | Bayou La Batre Area Health Development Bd.inc. | Clinic/Center | 1340 North Wintzell Ave., Bayou La Batre, AL 36509 | 2006-05-23 |
| 1619429248 | Franklin Primary Health Center, Inc. | Dentist | 13040 S. Wintzell Avenue, Bayou, La Batre, AL 36509-2110 | 2016-10-31 |
| 1407802457 | Carrie F. Tombrello | Dentist | 13040 N Wintzell Ave, Bayou La Batre, AL 36509-2110 | 2006-05-25 |
| 1427200971 | Encore Rehabilitation, Inc. | Clinic/Center | 13040 N Wintzell Ave, Office # 2, Bayou La Batre, AL 36509-2110 | 2008-10-15 |
| 1326356528 | Staci L. Shipman | Pharmacist | 13210 N Wintzell Ave, Bayou La Batre, AL 36509-2142 | 2010-09-22 |
| 1356677124 | Freds Stores of Tennessee Inc | Durable Medical Equipment & Medical Supplies | 13210 N Wintzell Ave, Bayou La Batre, AL 36509-2142 | 2009-10-28 |
| 1912972407 | Lloyds Pharmacy Inc | Pharmacy | 13286 N Wintzell Ave, Bayou La Batre, AL 36509-2146 | 2006-02-20 |
| 1801936943 | Rx Express Pharmacy of Bayou La Batre, Inc. | Durable Medical Equipment & Medical Supplies | 13286 N Wintzell Ave, Bayou La Batre, AL 36509-2146 | 2007-02-07 |
| Find all providers in zip 36509 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295212363 | Accordia Health, Inc. | Family Medicine | 13833 Tapia Ave, Bayou La Batre, AL 36509-2515 | 2018-07-23 |
| 1033504428 | Ashlen Aggen | Family Medicine | 13833 Tapia Ave, Bayou La Batre, AL 36509-2515 | 2015-04-01 |
| 1033188339 | Regina M Benjamin | Family Medicine | 13833 Tapia Ave, Bayou La Batre, AL 36509-2515 | 2006-03-17 |
| 1114996865 | Bayouclinic, Inc. | Family Medicine | 13833 Tapia Ave, Bayou La Batre, AL 36509-2515 | 2006-03-15 |
| 1720057490 | Kimberley E Jongebloed | Family Medicine | 13833 Tapia Ave, Bayou La Batre, AL 36509-2515 | 2006-03-15 |
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|---|---|---|---|---|
| 1164023529 | Aderholt Medical, LLC | Family Medicine | 320 Old Us-31 N, Athens, AL 35611 | 2020-11-03 |
| 1043810195 | Tempus Primary Care | Family Medicine | 4101 Balmoral Dr Sw Ste B, Huntsville, AL 35801-6535 | 2020-10-28 |
| 1497354617 | Southcoast Medical Services | Family Medicine | 34463 Us Highway 98 Ste G, Lillian, AL 36549-4049 | 2020-10-19 |
| 1154929131 | Jackson Tuley Cornelison | Family Medicine | 41 Eminence Way Ste A, Pell City, AL 35128-2338 | 2020-10-13 |
| 1740895200 | Escambia County Alabama Community Hospitals, Inc | Family Medicine | 609 E. Laurel Street, Atmore, AL 36502 | 2020-09-11 |
| 1336752088 | Christy Nicole Johnson | Family Medicine | 634 Drew Dr, Hollywood, AL 35752-6556 | 2020-08-24 |
| 1053920264 | Mms Life, LLC | Family Medicine | 401 Evergreen Ave, Brewton, AL 36426-2066 | 2020-07-24 |
| 1164040986 | Marshall Primary Care | Family Medicine | 7938 Al Highway 69 Ste 350, Guntersville, AL 35976-7135 | 2020-07-08 |
| 1750907507 | Agape Medicine, LLC | Family Medicine | 42598 State Highway 75, Snead, AL 35952-6566 | 2020-06-17 |
| 1750906921 | Doctors Making Home Visits 1st Inc | Family Medicine | 922 S Perry St, Montgomery, AL 36104-5022 | 2020-06-12 |
| Find all providers with the same taxonomy | ||||
| City | BAYOU LA BATRE |
| Zip Code | 36509 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.