Provider Demographics
NPI:1659708048
Name:ATKINS, KARISSA MIZNER
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:MIZNER
Last Name:ATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:FAE
Other - Last Name:MIZNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 JOHNNY MERCER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-2118
Mailing Address - Country:US
Mailing Address - Phone:662-701-1327
Mailing Address - Fax:
Practice Address - Street 1:2 SAINT IVES DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-8910
Practice Address - Country:US
Practice Address - Phone:662-701-1327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist