Provider Demographics
NPI:1952130429
Name:MIMS, JOHN DRURY JR
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DRURY
Last Name:MIMS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 GOVERNORS LN NW
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-6823
Mailing Address - Country:US
Mailing Address - Phone:803-634-2848
Mailing Address - Fax:
Practice Address - Street 1:164 GOVERNORS LN NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6823
Practice Address - Country:US
Practice Address - Phone:803-634-2848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC250001163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine