Provider Demographics
NPI:1801958137
Name:MITCHELL, TERESA LANETTE (PHARMD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LANETTE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7544 N TURKEY RD
Mailing Address - Street 2:
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730-5500
Mailing Address - Country:US
Mailing Address - Phone:229-336-7931
Mailing Address - Fax:
Practice Address - Street 1:7544 N TURKEY RD
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-5500
Practice Address - Country:US
Practice Address - Phone:229-336-7931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist