Provider Demographics
NPI:1831952811
Name:MITCHELL, STEFANI JANE
Entity type:Individual
Prefix:
First Name:STEFANI
Middle Name:JANE
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 1:560 AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-2314
Mailing Address - Country:US
Mailing Address - Phone:315-663-4529
Mailing Address - Fax:
Practice Address - Street 1:2400 BUFORD DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-2570
Practice Address - Country:US
Practice Address - Phone:315-633-4529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other