Provider Demographics
NPI:1013747799
Name:MILLINGTON, MINDY E (MED, LMT)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:E
Last Name:MILLINGTON
Suffix:
Gender:F
Credentials:MED, LMT
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:E
Other - Last Name:HIGGINBOTHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1010 N TENNESSEE ST STE 214
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-8528
Mailing Address - Country:US
Mailing Address - Phone:470-227-1669
Mailing Address - Fax:305-890-2721
Practice Address - Street 1:1010 N TENNESSEE ST STE 214
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8528
Practice Address - Country:US
Practice Address - Phone:470-227-1669
Practice Address - Fax:305-890-2721
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
GAMT003309225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach