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MRS. STACEY LASANDRA MITCHELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
320 LANIER AVE W STE 200, FAYETTEVILLE, GA 30214-7443
(678) 590-1232
(470) 381-1502
Mailing address
1415 HIGHWAY 85 N STE 310-390, FAYETTEVILLE, GA 30214-7738
(470) 381-1502

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
203475
GA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
403153
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1245794387
NPI
GA
Enumeration date
01/23/2019
Last updated
09/16/2024
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