Individual
DR. JAN KAREN MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1430 JOHN WESLEY GILBERT DRIVE, AUGUSTA, GA 30912-1001
(706) 721-2371
(706) 721-6778
Mailing address
1430 JOHN WESLEY GILBERT DRIVE GC-1012, AUGUSTA, GA 30912-0001
(706) 721-2371
(706) 721-6778
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN009079
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1418385
TRICARE
GA
05
—
ZG9079
—
SC
Enumeration date
04/19/2007
Last updated
03/25/2021
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