Provider Demographics
NPI:1831184027
Name:MITCHELL, KARLINE WILSON (CNM)
Entity type:Individual
Prefix:MRS
First Name:KARLINE
Middle Name:WILSON
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KARLINE
Other - Middle Name:E
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:37 TAWN CRESCENT
Mailing Address - Street 2:
Mailing Address - City:AJAX
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L1Z1H9
Mailing Address - Country:CA
Mailing Address - Phone:416-909-1791
Mailing Address - Fax:
Practice Address - Street 1:2675 N DECATUR RD
Practice Address - Street 2:STE 512
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6131
Practice Address - Country:US
Practice Address - Phone:404-508-2000
Practice Address - Fax:404-508-5560
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN168891367A00000X
FLARNP1967452367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA611377940ABMedicaid
GRP632OtherGROUP MEDICARE
GA611377940ABMedicaid
GRP632OtherGROUP MEDICARE