Individual
KENENNESHA LATASHA MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EMT-I
Contact information
Practice address
2467 GOLDEN CAMP RD, AUGUSTA, GA 30906-5515
(706) 790-4440
(706) 790-4393
Mailing address
2467 GOLDEN CAMP RD, AUGUSTA, GA 30906-5515
(706) 790-4440
(706) 790-4393
Taxonomy
Speciality
Code
Description
License number
State
146M00000X
Intermediate Emergency Medical Technician
Primary
29545
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29545
EMT-I
GA
Enumeration date
10/31/2012
Last updated
10/31/2012
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