Provider Demographics
NPI:1235609579
Name:MITCHELL, DANIELLE RENEE'
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RENEE'
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CONSTITUTION CT APT A
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-2161
Mailing Address - Country:US
Mailing Address - Phone:706-325-4943
Mailing Address - Fax:
Practice Address - Street 1:111 CONSTITUTION CT APT A
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-2161
Practice Address - Country:US
Practice Address - Phone:706-325-4943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor