Healthcare Provider Details

I. General information

NPI: 1780479493
Provider Name (Legal Business Name): MARGARET ANN MIZWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2025
Last Update Date: 04/12/2025
Certification Date: 04/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 POTTS RD
TIFTON GA
31794-3627
US

IV. Provider business mailing address

615 POTTS RD
TIFTON GA
31794-3627
US

V. Phone/Fax

Practice location:
  • Phone: 931-248-1644
  • Fax: 931-248-1644
Mailing address:
  • Phone: 931-248-1644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: