Healthcare Provider Details

I. General information

NPI: 1407767437
Provider Name (Legal Business Name): TERRIA MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N FAYETTE DR
FAYETTEVILLE GA
30214-3435
US

IV. Provider business mailing address

420 N FAYETTE DR
FAYETTEVILLE GA
30214-3435
US

V. Phone/Fax

Practice location:
  • Phone: 470-921-4848
  • Fax:
Mailing address:
  • Phone: 470-921-4848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: