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NPI Code Detail

MEDICARE: LULA SHERRI M MITCHELL PA

MEDICARE: LULA SHERRI M MITCHELL PA
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
1363AM0700XMedical Physician Assistant1417GA

General Provider Information

NPI Number : 1710082458
Entity Type Code : Individual
Provider Name (Legal Business Name) : LULA SHERRI M MITCHELL PA
Provider Business Mailing Address
First Line : PO BOX 741539
Second Line :
City : RIVERDALE
State : GA
Zip : 30274-1328
Country : US
Telephone Number : 770-907-4949
Fax Number :
Provider Business Practice Location Address
First Line : 1324 HIGHWAY 138 SW
Second Line :
City : RIVERDALE
State : GA
Zip : 30296-1404
Country : US
Telephone Number : 770-907-4949
Fax Number : 770-907-4022
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2006
Last Update Date : 07/08/2007

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Directions to “ LULA SHERRI M MITCHELL PA” Practice Location

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