Healthcare Provider Details

I. General information

NPI: 1255706446
Provider Name (Legal Business Name): MEGAN E MIZELL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 S 1ST ST
JESUP GA
31545-1132
US

IV. Provider business mailing address

2730 US HIGHWAY 441 N
PEARSON GA
31642-4839
US

V. Phone/Fax

Practice location:
  • Phone: 912-427-8433
  • Fax:
Mailing address:
  • Phone: 912-422-4839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN211371
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: