Provider Demographics
NPI:1437259785
Name:MIRACLE MAKING MINISTRIES, INC.
Entity Type:Organization
Organization Name:MIRACLE MAKING MINISTRIES, INC.
Other - Org Name:DRUID PARK COMMUNITY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-722-8693
Mailing Address - Street 1:PO BOX 10044
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-2644
Mailing Address - Country:US
Mailing Address - Phone:706-722-8693
Mailing Address - Fax:706-722-8695
Practice Address - Street 1:1127 DRUID PARK AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5849
Practice Address - Country:US
Practice Address - Phone:706-722-8693
Practice Address - Fax:706-722-8695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7143Medicare ID - Type Unspecified