Clinton, Mymie T

Clinton, Mymie T is an individual health care provider with primary practice located at 118 Alice Coleman Dr , Vidalia GA 30474-8860. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Clinton, Mymie T can be contacted via phone (912) 537-6565.

Contact Information

Primary practice address
118 Alice Coleman Dr Vidalia GA 30474-8860
Phone: (912) 537-6565
Fax: (912) 537-6161
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X RN040042 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X RN040042 Georgia

Profile Details

NPI number 1881625598
LBN Legal business name Clinton, Mymie T
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 5th, 2006
Last updated Jan 30th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881625598 NPPES
Georgia Other 000632376L FQHC MEDICAID
Georgia MEDICAID 339898116D FQHC MEDICAID

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