Provider Demographics
NPI:1386998375
Name:MITCHELL, SHARON JEANNETTE (GA LMT, NCBTMB)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:JEANNETTE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:GA LMT, NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10498 CEDAR GROVE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-1884
Mailing Address - Country:US
Mailing Address - Phone:229-400-7321
Mailing Address - Fax:
Practice Address - Street 1:10498 CEDAR GROVE RD
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-1884
Practice Address - Country:US
Practice Address - Phone:229-400-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT001122225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist