Healthcare Provider Details

I. General information

NPI: 1659062883
Provider Name (Legal Business Name): MS. MONIQUE ELISE MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 COLLIER RD NW STE 400
ATLANTA GA
30309-1711
US

IV. Provider business mailing address

193 CAMDALE CT
MCDONOUGH GA
30252-2305
US

V. Phone/Fax

Practice location:
  • Phone: 404-660-5484
  • Fax:
Mailing address:
  • Phone: 813-506-3188
  • Fax: 929-410-6027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9364702
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberGAA-NP001457
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: