Individual
MR. RYAN MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
2556 GLENDALE CT NE, CONYERS, GA 30013-1455
(770) 722-1347
(770) 761-9755
Mailing address
PO BOX 82750, CONYERS, GA 30013-9441
(770) 722-1347
(770) 761-9755
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT003400
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52873411001
BC BS OF GEORGIA
GA
Enumeration date
12/18/2006
Last updated
07/09/2007
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