Individual
SUSAN MIZELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
400 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-6035
(423) 431-6111
Mailing address
1185 W MOUNTAIN VIEW RD, APARTMENT 1301, JOHNSON CITY, TN 37604-2523
(423) 276-4033
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1883
TN
363AS0400X
Surgical Physician Assistant
Primary
1883
TN
Other
Enumeration date
09/20/2010
Last updated
10/16/2024
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