Provider Demographics
NPI:1669260642
Name:SHAUNA H. MITCHELL DDS PC
Entity type:Organization
Organization Name:SHAUNA H. MITCHELL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMMAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-805-1454
Mailing Address - Street 1:3662 FLAKES MILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5219
Mailing Address - Country:US
Mailing Address - Phone:770-593-2202
Mailing Address - Fax:770-593-2602
Practice Address - Street 1:3662 FLAKES MILL RD STE A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5219
Practice Address - Country:US
Practice Address - Phone:770-593-2202
Practice Address - Fax:770-593-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental