Individual
MR. JUSTIN T MIZELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
400 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-6035
(888) 632-1085
Mailing address
400 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-6035
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2025
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1526919
—
TN
Enumeration date
09/15/2011
Last updated
03/17/2018
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