Healthcare Provider Details

I. General information

NPI: 1073310165
Provider Name (Legal Business Name): ELIZABETH MITCHELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SIGMAN RD NE STE 180
CONYERS GA
30012-3924
US

IV. Provider business mailing address

1301 SIGMAN RD NE STE B180
CONYERS GA
30012-3812
US

V. Phone/Fax

Practice location:
  • Phone: 770-922-4024
  • Fax:
Mailing address:
  • Phone: 770-922-4024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberGAA-NP003654
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11038622
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP003654
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: