Provider Demographics
NPI:1831737949
Name:MITCHELL, SUMONA (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:MS
First Name:SUMONA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:MS
Other - First Name:SUMONA
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CERTIFIED HAIR LOSS
Mailing Address - Street 1:1800 STALEY AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-3836
Mailing Address - Country:US
Mailing Address - Phone:803-260-7427
Mailing Address - Fax:
Practice Address - Street 1:1100 EISENHOWER DRIVE 15
Practice Address - Street 2:SUITE 7
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-499-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO0936711744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management