Provider Demographics
NPI:1275691644
Name:MITCHELL, FELICIA M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3637 TURNER CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-5686
Mailing Address - Country:US
Mailing Address - Phone:770-507-1234
Mailing Address - Fax:770-507-1011
Practice Address - Street 1:1920 HUDSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5038
Practice Address - Country:US
Practice Address - Phone:770-507-1234
Practice Address - Fax:770-507-1011
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist