Provider Demographics
NPI:1891331674
Name:BERRY'MITCHELL, SYLVESTER W (CNA)
Entity type:Individual
Prefix:MR
First Name:SYLVESTER
Middle Name:W
Last Name:BERRY'MITCHELL
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 MARKET SQUARE LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-3166
Mailing Address - Country:US
Mailing Address - Phone:404-983-2599
Mailing Address - Fax:
Practice Address - Street 1:1180 MARKET SQUARE LN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-3166
Practice Address - Country:US
Practice Address - Phone:404-983-2599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0000003050376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide