Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | LDO001188 | GA |
NPI | 1225320336 |
---|---|
Provider Name | Mrs. Sharon Chenell Mitchell |
First Address | Jonesboro, GA 30238-6308 |
Second Address | Jonesboro, GA 30236-1227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2011 |
Last Update Date | 07/05/2011 |