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General NPI Number Information
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NPI Number | 1831952811
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Entity Type | Individual
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Provider Name | STEFANI JANE MITCHELL
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Gender | Female
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Dates
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Enumeration Date | 02/02/2024
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 2400 BUFORD DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-2570
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Country | US
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Telephone | 315-633-4529
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Fax |
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Provider Business Mailing Address
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Address Line | 560 AUBURN RD
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City | AUBURN
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State | GA
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Zip | 30011-2314
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Country | US
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Telephone | 315-663-4529
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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