Healthcare Provider Details

I. General information

NPI: 1659268548
Provider Name (Legal Business Name): JERRI ELIZABETH MIXON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 E OGLETHORPE HWY
HINESVILLE GA
31313-1200
US

IV. Provider business mailing address

2201 OLD HINES RD
HINESVILLE GA
31313-1165
US

V. Phone/Fax

Practice location:
  • Phone: 912-321-8368
  • Fax:
Mailing address:
  • Phone: 912-321-8368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN223003
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: