Provider Demographics
NPI:1184873069
Name:MITCHELL, JEANETTE BROWN (NP)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:BROWN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:LAVERN
Other - Last Name:BROWN MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:300 BULL ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-4347
Mailing Address - Country:US
Mailing Address - Phone:912-231-9956
Mailing Address - Fax:912-232-1148
Practice Address - Street 1:300 BULL ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-4347
Practice Address - Country:US
Practice Address - Phone:912-231-9956
Practice Address - Fax:912-232-1148
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN118861363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA461330251DMedicaid
GAP01003828OtherRAILROAD MEDICARE
GAP01003828OtherRAILROAD MEDICARE