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General NPI Number Information
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NPI Number | 1104740794
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Entity Type | Individual
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Provider Name | MADISON MITCHELL
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Gender | Female
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Dates
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Enumeration Date | 08/06/2026
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Last Update Date | 08/06/2026
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Provider Practice Location Address
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Address Line | 2061 PEACHTREE RD NW #500
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City | ATLANTA
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State | GA
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Zip | 30309
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Country | US
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Telephone | 404-551-2205
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 STILLWOOD PL
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City | JEFFERSON
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State | GA
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Zip | 30549-3103
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | GA
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