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General NPI Number Information
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NPI Number | 1871129361
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Entity Type | Individual
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Provider Name | MICHAELA MITCHELL
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Gender | Female
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Dates
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Enumeration Date | 03/17/2020
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Last Update Date | 03/17/2020
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Provider Practice Location Address
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Address Line | 5366 WINCHESTER RD
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City | MEMPHIS
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State | TN
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Zip | 38115-4565
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Country | US
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Telephone | 901-550-5253
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Fax |
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Provider Business Mailing Address
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Address Line | 1799 AUTUMNDALE DR
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City | CORDOVA
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State | TN
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Zip | 38016-8599
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Country | US
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Telephone | 901-550-5253
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 7724
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License Number State | TN
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