Provider Demographics
NPI:1396055315
Name:MITCHELL, MONICA (RN)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 HORSESHOE LN
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-2353
Mailing Address - Country:US
Mailing Address - Phone:678-567-9264
Mailing Address - Fax:678-567-9632
Practice Address - Street 1:182 HORSESHOE LN
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2353
Practice Address - Country:US
Practice Address - Phone:678-567-9264
Practice Address - Fax:678-567-9632
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN178263171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator