MINI-MED CLINIC OF NORTH GEORGIA
NPI 1124792106
Clinic/Center in Canton, GA
About Mini-med Clinic Of North Georgia NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MINI-MED CLINIC OF NORTH GEORGIA (NPI 1124792106) is a healthcare organization registered as a clinic/center in Canton, Georgia and active in the NPI registry since August 2021. The organization holds a CLIA Waiver certificate valid through August 9, 2027 and lists Sophia Kennedy, Nurse Practitioner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mini-med Clinic Of North Georgia is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by November 30, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Mini-Med Clinic Of North Georgia, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 11D2232018
Mini-Med Clinic Of North Georgia, LLC · Canton, GAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Mini-Med Clinic Of North Georgia, LLC's NPI number?
The NPI number for Mini-Med Clinic Of North Georgia, LLC is 1124792106. It was assigned to this organization in the NPPES registry on August 4, 2021. The provider is doing business as Mini-Med Clinic Of North Georgia.
Where is Mini-Med Clinic Of North Georgia, LLC located?
Mini-Med Clinic Of North Georgia, LLC is located at 5113 Holly Springs Parkway, Canton, GA 30115. The listed phone number is (470) 331-3544.
What is Mini-Med Clinic Of North Georgia, LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.
Is Mini-Med Clinic Of North Georgia, LLC enrolled in Medicare?
Yes. Mini-Med Clinic Of North Georgia, LLC is registered in the Medicare PECOS enrollment system.
When is Mini-Med Clinic Of North Georgia, LLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Georgia, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Mini-Med Clinic Of North Georgia, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Mini-Med Clinic Of North Georgia, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Mini-Med Clinic Of North Georgia, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 11D2232018) is associated with this NPI, valid through August 9, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Mini-Med Clinic Of North Georgia, LLC accept?
Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Mini-Med Clinic Of North Georgia, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Mini-Med Clinic Of North Georgia, LLC was last updated on August 27, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mini-Med Clinic Of North Georgia · NPI 1124792106
Clinic/Center organization in Canton, Georgia. Organization record, active in the CMS NPPES registry since August 4, 2021.
## Identity
- **NPI:** 1124792106 (Entity type: Organization)
- **Enumerated:** August 4, 2021
- **Primary specialty:** Clinic/Center · taxonomy 261Q00000X
- **Legal business name:** Mini-Med Clinic Of North Georgia, Llc
- **Organization subpart:** No
- **Authorized official:** Sophia Kennedy, NURSE PRACTITIONER
## Practice location
- **Address:** 5113 HOLLY SPRINGS PARKWAY, Canton, GA 30115
- **Phone:** (470) 331-3544
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** November 30, 2026 (Non-DME Part B, Georgia, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 27, 2021
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1124792106) · Data from the CMS NPPES public registry.