| Shelly Mixson | |
|
1133 E West Connector Austell GA 30106-1589 | |
| (770) 333-9951 | |
| (770) 333-9953 |
| Full Name | Shelly Mixson |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1133 E West Connector, Austell, Georgia |
| Authorized Official Name and Position | Shelly Mixson (OWNER) |
| Authorized Official Contact | 7703339951 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shelly Mixson 1133 E West Connector Austell GA 30106-1589 Ph: (770) 333-9951 | Shelly Mixson 1133 E West Connector Austell GA 30106-1589 Ph: (770) 333-9951 |
| NPI Number | 1861664880 |
|---|---|
| Provider Enumeration Date | 03/31/2008 |
| Last Update Date | 03/31/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861664880 | NPI | - | NPPES |
| 101592 | Other | GA | AVESIS |
| 9185964 | Other | GA | DORAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN012436 (Georgia) | Primary |
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