Provider Demographics
NPI:1336575596
Name:MITCHELL, MARGUERITE LUCY
Entity Type:Individual
Prefix:MS
First Name:MARGUERITE
Middle Name:LUCY
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1525 CLIFTON RD NE
Mailing Address - Street 2:RM. 223
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-4200
Mailing Address - Country:US
Mailing Address - Phone:404-727-0392
Mailing Address - Fax:404-727-5349
Practice Address - Street 1:1525 CLIFTON RD NE
Practice Address - Street 2:RM. 223
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-4200
Practice Address - Country:US
Practice Address - Phone:404-727-0392
Practice Address - Fax:404-727-5349
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN119067163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health