Healthcare Provider Details

I. General information

NPI: 1972539716
Provider Name (Legal Business Name): ELIZABETH BARNES MIXSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3931 MUNDY MILL RD
OAKWOOD GA
30566-3413
US

IV. Provider business mailing address

1678 OAK LN NE
ATLANTA GA
30329-2516
US

V. Phone/Fax

Practice location:
  • Phone: 404-728-8235
  • Fax:
Mailing address:
  • Phone: 404-728-8235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number038056
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: