Provider Demographics
NPI:1053474767
Name:MITCHELL, CHERYL M (RD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1715
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30515-8715
Mailing Address - Country:US
Mailing Address - Phone:770-744-3189
Mailing Address - Fax:
Practice Address - Street 1:2550 HAMILTON MILL RD STE 13
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-3611
Practice Address - Country:US
Practice Address - Phone:770-744-3189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003307133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty