Provider Demographics
NPI:1750933123
Name:MITCHELL, GERMAINE L
Entity type:Individual
Prefix:MS
First Name:GERMAINE
Middle Name:L
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 GROVE WAY APT 23
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6504
Mailing Address - Country:US
Mailing Address - Phone:678-499-3660
Mailing Address - Fax:
Practice Address - Street 1:148 GROVE WAY APT 23
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-6504
Practice Address - Country:US
Practice Address - Phone:678-499-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0000006847376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide