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NPI Code Detail

MEDICARE: MRS. NATALIE MITCHELL MA, BCBA

MEDICARE: MRS. NATALIE MITCHELL MA, BCBA
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
1103K00000XBehavior Analyst1-21-47564

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-21-47564OTHERBACB

General Provider Information

NPI Number : 1679073076
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NATALIE MITCHELL MA, BCBA
Provider Business Mailing Address
First Line : 225 SMITHVILLE CHURCH RD STE 1100
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31088-9097
Country : US
Telephone Number : 800-832-9419
Fax Number :
Provider Business Practice Location Address
First Line : 225 SMITHVILLE CHURCH RD STE 1100
Second Line :
City : WARNER ROBINS
State : GA
Zip : 31088-9097
Country : US
Telephone Number : 478-508-1970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2018
Last Update Date : 07/31/2024

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