Provider Demographics
NPI:1972767168
Name:MITCHELL, MARYLEE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MARYLEE
Middle Name:
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 1:707 WHITLOCK AVE SW STE A40
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4654
Mailing Address - Country:US
Mailing Address - Phone:678-499-0183
Mailing Address - Fax:770-943-8772
Practice Address - Street 1:3091 PERCH OVERLOOK SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-5972
Practice Address - Country:US
Practice Address - Phone:678-499-0183
Practice Address - Fax:770-943-8772
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN104948163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse