=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952598807
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONNA M MITCHELL CPM, CPM-TN, CLC,
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2007
-----------------------------------------------------
Last Update Date | 06/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 58 TAMBOURINE LN
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35603-3723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-657-1845
-----------------------------------------------------
Fax | 256-309-5679
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 58 TAMBOURINE LN
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35603-3723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-353-2592
-----------------------------------------------------
Fax | 256-309-5679
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133N00000X
-----------------------------------------------------
Taxonomy Name | Nutritionist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | 49
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 174N00000X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Non-RN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------