Provider Demographics
NPI:1255706446
Name:MIZELL, MEGAN E (FNP-BC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:E
Last Name:MIZELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 US HIGHWAY 441 N
Mailing Address - Street 2:
Mailing Address - City:PEARSON
Mailing Address - State:GA
Mailing Address - Zip Code:31642-4839
Mailing Address - Country:US
Mailing Address - Phone:912-422-4839
Mailing Address - Fax:
Practice Address - Street 1:391 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-1132
Practice Address - Country:US
Practice Address - Phone:912-427-8433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN211371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine