Provider Demographics
NPI:1730484866
Name:MITCHELL, MITZI BRUTUS (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:MITZI
Middle Name:BRUTUS
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 MOUNT ZION RD # 293
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-3313
Mailing Address - Country:US
Mailing Address - Phone:678-490-5490
Mailing Address - Fax:
Practice Address - Street 1:104 WINDSOR WAY
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-3659
Practice Address - Country:US
Practice Address - Phone:678-490-5490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN165674163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse