Healthcare Provider Details

I. General information

NPI: 1053474767
Provider Name (Legal Business Name): CHERYL M MITCHELL RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1862 AUBURN RD STE 118-Q5
DACULA GA
30019-1676
US

IV. Provider business mailing address

PO BOX 1715
BUFORD GA
30515-8715
US

V. Phone/Fax

Practice location:
  • Phone: 770-744-1995
  • Fax:
Mailing address:
  • Phone: 770-744-1995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD003307
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: