Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CHIR010004 | GA |
NPI | 1124520937 |
---|---|
Provider Name | Antjuan D Mitchell |
First Address | Atlanta, GA 30331-8014 |
Second Address | Atlanta, GA 30331-8014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2018 |
Last Update Date | 07/03/2018 |