Provider Demographics
NPI:1770111361
Name:MITCHELL, DONNA BETTY (PMHNP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:BETTY
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 NORTHSTAR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-6348
Mailing Address - Country:US
Mailing Address - Phone:706-533-6311
Mailing Address - Fax:
Practice Address - Street 1:48 NORTHSTAR DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-6348
Practice Address - Country:US
Practice Address - Phone:706-533-6311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN276917363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA061156050OtherDRIVER LICENSE