Healthcare Provider Details

I. General information

NPI: 1942589734
Provider Name (Legal Business Name): JUNE MITCHELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5524 OLD NATIONAL HWY STE B
COLLEGE PARK GA
30349-3212
US

IV. Provider business mailing address

3665 CLUB DR STE 107
DULUTH GA
30096-1806
US

V. Phone/Fax

Practice location:
  • Phone: 404-763-8555
  • Fax: 404-763-8502
Mailing address:
  • Phone: 678-288-6550
  • Fax: 800-609-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN078862
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: