MEDICARE: TYSHAWN MITCHELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT015698	GA

General Provider Information

NPI Number	:	1639009434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYSHAWN MITCHELL

Provider Business Mailing Address
First Line	:	2221 PEACHTREE RD NE STE 6
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1148
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3865 SHACKLEFORD RD APT 548
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-8341
Country	:	US
Telephone Number	:	737-808-1457
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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Directions to “ TYSHAWN MITCHELL ” Practice Location

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