Individual
JOSHUA TIMOTHY MIZELLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4439 COUNTRY CLUB RD, STATESBORO, GA 30458-9188
(912) 489-7979
(912) 489-6744
Mailing address
PO BOX 2698, STATESBORO, GA 30459-2698
(912) 489-7979
(912) 489-6744
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH025110
GA
Other
Enumeration date
12/22/2020
Last updated
12/22/2020
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