Healthcare Provider Details

I. General information

NPI: 1619067923
Provider Name (Legal Business Name): JANET BEECHAM MIXSON L.AC., DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2006
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 SAINT MARYS RD STE A
SAINT MARYS GA
31558-4284
US

IV. Provider business mailing address

1033 GREENWILLOW DR
SAINT MARYS GA
31558-4147
US

V. Phone/Fax

Practice location:
  • Phone: 912-882-1200
  • Fax:
Mailing address:
  • Phone: 912-882-8877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2136
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000171
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: