Healthcare Provider Details

I. General information

NPI: 1720021843
Provider Name (Legal Business Name): ANGELA BARTON MIXON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA BARTON FNP

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 EISENHOWER DR STE 12A
SAVANNAH GA
31406-2632
US

IV. Provider business mailing address

310 EISENHOWER DR STE 12A
SAVANNAH GA
31406-2632
US

V. Phone/Fax

Practice location:
  • Phone: 912-201-1140
  • Fax: 912-352-4065
Mailing address:
  • Phone: 912-201-1140
  • Fax: 912-352-4065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN115484
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: