Provider Demographics
NPI:1548762636
Name:MITCHELL, JENAE
Entity Type:Individual
Prefix:
First Name:JENAE
Middle Name:
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 1:4796 BROWNS MILL FERRY RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4534
Mailing Address - Country:US
Mailing Address - Phone:816-674-8845
Mailing Address - Fax:816-674-8845
Practice Address - Street 1:4796 BROWNS MILL FERRY RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-4534
Practice Address - Country:US
Practice Address - Phone:816-674-8845
Practice Address - Fax:816-674-8845
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management