MEDICARE: MR. AUNDRE R. MITCHELL FNP-BC

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	363LF0000X	Family Nurse Practitioner	RN206296	GA

General Provider Information

NPI Number	:	1669754214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AUNDRE R. MITCHELL FNP-BC

Provider Business Mailing Address
First Line	:	215 N BROAD ST
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-1843
Country	:	US
Telephone Number	:	800-993-8244
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 N BROAD ST
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-1843
Country	:	US
Telephone Number	:	229-271-9330
Fax Number	:	229-271-9245

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

Provider Enumeration Date	:	09/09/2011
Last Update Date	:	07/18/2019

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