Provider Demographics
NPI:1619067923
Name:MIXSON, JANET BEECHAM (LAC, DOM)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:BEECHAM
Last Name:MIXSON
Suffix:
Gender:F
Credentials:LAC, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 GREENWILLOW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-4147
Mailing Address - Country:US
Mailing Address - Phone:912-882-8877
Mailing Address - Fax:
Practice Address - Street 1:2300 SAINT MARYS RD STE A
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-4284
Practice Address - Country:US
Practice Address - Phone:912-882-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2136171100000X
GA000171171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist