Mystic Medical, LLC
NPI 1093108763 · Foot & Ankle Surgery Podiatrist · Atlanta, GA
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Mystic Medical, LLC is a Foot & Ankle Surgery Podiatrist organization in Atlanta, GA (NPI 1093108763).
Provider details
- NPI number
- 1093108763
- Entity type
- Organization
- Primary specialty
- Foot & Ankle Surgery PodiatristPodiatric Medicine & Surgery Service Providers
- Organization subpart
- No
- Authorized official
- Amanda Dykes, Admin(404) 351-0055
Specialties & taxonomies
Podiatric Medicine & Surgery Service Providers
- Optometrist152W00000X
Eye and Vision Services Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
11 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2015-03-05
- Last updated
- 2025-03-25
- Certified
- 2025-03-25
Frequently asked questions
- What is Mystic Medical, LLC's NPI number?
- Mystic Medical, LLC's National Provider Identifier (NPI) is 1093108763, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Mystic Medical, LLC?
- Mystic Medical, LLC is classified in the NPPES registry as Foot & Ankle Surgery Podiatrist (Podiatric Medicine & Surgery Service Providers).
- Where is Mystic Medical, LLC located?
- Mystic Medical, LLC's practice location on file with NPPES is 5555 Glenridge Connector, Atlanta, GA 30342-4759.
- What is Mystic Medical, LLC's phone number?
- The practice phone number listed in the NPPES registry for Mystic Medical, LLC is (404) 351-0055.
- Does Mystic Medical, LLC accept Medicare?
- Mystic Medical, LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Mystic Medical, LLC?
- The authorized official listed on Mystic Medical, LLC's NPPES record is Amanda Dykes, Admin. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Mystic Medical, LLC's NPI active?
- Yes — Mystic Medical, LLC's NPI (1093108763) is active in the NPPES registry as of the last update on 2025-03-25.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.