Basic Information
| Provider Information | |||||||||
| NPI: | 1154576361 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | JOAN | ||||||||
| MiddleName: | SAPP | ||||||||
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| Credential: | RN,MSN,PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5228 BRANDYWINE DRIVE | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4782841116 | ||||||||
| FaxNumber: | 4784742150 | ||||||||
| Practice Location | |||||||||
| Address1: | 940 HIGHWAY 96 | ||||||||
| Address2: | |||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789887108 | ||||||||
| FaxNumber: | 4787514444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2008 | ||||||||
| LastUpdateDate: | 05/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | RN063812 | GA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.