Provider Demographics
NPI:1952598807
Name:MITCHELL, DONNA M (CPM, CPM-TN, CLC,)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CPM, CPM-TN, CLC,
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:M
Other - Last Name:KNOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DEM
Mailing Address - Street 1:58 TAMBOURINE LN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-3723
Mailing Address - Country:US
Mailing Address - Phone:256-353-2592
Mailing Address - Fax:256-309-5679
Practice Address - Street 1:58 TAMBOURINE LN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-3723
Practice Address - Country:US
Practice Address - Phone:205-657-1845
Practice Address - Fax:256-309-5679
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X, 174N00000X
TN49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN