Provider Demographics
NPI:1578784013
Name:MITCHELL, AIMEE M (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:M
Last Name:MITCHELL
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Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:111 MARBLE MILL RD NW
Mailing Address - Street 2:MARIETTA DERMATOLOGY ASSOCIATES PA
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1047
Mailing Address - Country:US
Mailing Address - Phone:770-422-1013
Mailing Address - Fax:770-514-5996
Practice Address - Street 1:130 OAKSIDE COURT
Practice Address - Street 2:STE A MARIETTA DERMATOLOGY ASSOCIATES PA
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114
Practice Address - Country:US
Practice Address - Phone:770-422-1013
Practice Address - Fax:770-514-5996
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2010-06-28
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Provider Licenses
StateLicense IDTaxonomies
GA003900363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P68485Medicare UPIN