Healthcare Provider Details

I. General information

NPI: 1669754214
Provider Name (Legal Business Name): AUNDRE R. MITCHELL FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N BROAD ST
MONROE GA
30655-1843
US

IV. Provider business mailing address

215 N BROAD ST
MONROE GA
30655-1843
US

V. Phone/Fax

Practice location:
  • Phone: 229-271-9330
  • Fax: 229-271-9245
Mailing address:
  • Phone: 800-993-8244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN206296
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: