Provider Demographics
NPI:1417249343
Name:MIZELL, JOSHUA BRETT (DC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:BRETT
Last Name:MIZELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 ASHLEY ST W
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2308
Mailing Address - Country:US
Mailing Address - Phone:912-427-8433
Mailing Address - Fax:912-427-9851
Practice Address - Street 1:506 ASHLEY ST W
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2308
Practice Address - Country:US
Practice Address - Phone:912-427-8433
Practice Address - Fax:912-427-9851
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2017-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor