Provider Demographics
NPI:1043273444
Name:MIMS, LINDSAY G (CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:G
Last Name:MIMS
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SUNSET CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768
Mailing Address - Country:US
Mailing Address - Phone:229-985-2080
Mailing Address - Fax:229-890-3397
Practice Address - Street 1:300 SUNSET CIRCLE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768
Practice Address - Country:US
Practice Address - Phone:229-985-2080
Practice Address - Fax:229-890-3397
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005981235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist