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Contact Information

MIXED MEDICAL MEDIA
1106 HOSPITAL DR
STOCKBRIDGE, GA30281
 Phone: 678-902-9495
 Fax: 678-815-1548
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
Indicates primary specialty

NPI Profile & details for MIXED MEDICAL MEDIA

NPI Number 1912875402
LBN Legal business name MIXED MEDICAL MEDIA
Authorized official AARON FLETCHER - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 10/27/2025
Last updated 10/27/2025 - About 7 months ago
Identifiers
GA Medicaid 003151504E
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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