Provider Demographics
NPI:1225320336
Name:MITCHELL, SHARON C (LDO)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:C
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 ARROWHEAD STE-400
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1227
Mailing Address - Country:US
Mailing Address - Phone:678-369-8676
Mailing Address - Fax:678-519-5587
Practice Address - Street 1:499 ARROWHEAD STE-400
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1227
Practice Address - Country:US
Practice Address - Phone:678-369-8676
Practice Address - Fax:678-519-5587
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-07
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO001188156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003111763AMedicaid