Healthcare Provider Details

I. General information

NPI: 1811802788
Provider Name (Legal Business Name): MICHELZA MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 OLD ALABAMA RD
JOHNS CREEK GA
30022-8594
US

IV. Provider business mailing address

3948 HAMMONDS FRY
EVANS GA
30809-8026
US

V. Phone/Fax

Practice location:
  • Phone: 770-552-8852
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018550
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: