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General NPI Number Information
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NPI Number | 1609501444
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Entity Type | Individual
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Provider Name | JASMINE MITCHELL LMT
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Gender | Female
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Dates
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Enumeration Date | 07/17/2022
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Last Update Date | 07/17/2022
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Provider Practice Location Address
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Address Line | 1115 MOUNT ZION RD SUITE A2, UNIT 1
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City | MORROW
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State | GA
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Zip | 30260
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Country | US
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Telephone | 470-444-2224
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Fax |
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Provider Business Mailing Address
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Address Line | 1748 NATCHEZ TRL
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City | CONLEY
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State | GA
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Zip | 30288-1323
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Country | US
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Telephone | 678-663-3264
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT011639
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License Number State | GA
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