Healthcare Provider Details

I. General information

NPI: 1326391491
Provider Name (Legal Business Name): TENISHA MITCHELL DNP, AGACNP-BC, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

744 OAK DR
RIVERDALE GA
30274-4123
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-4391
  • Fax:
Mailing address:
  • Phone: 404-429-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN177143
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN177143
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: