Jacqueline Mitchell, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA004231 Issued in GA

Practice address

990 E Main St Ste 7
Blue Ridge, GA 30513-4534

Phone

(706) 946-2035

Fax

(706) 946-2036

NPI assigned

Apr 18, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555545600000",
    "number": "1407419179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6397 LEE HWY STE 300",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374214915",
            "telephone_number": "423-238-7217",
            "fax_number": "423-238-3473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 E MAIN ST STE 7",
            "city": "BLUE RIDGE",
            "state": "GA",
            "postal_code": "305134534",
            "telephone_number": "706-946-2035",
            "fax_number": "706-946-2036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "JACQUELINE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-18",
        "last_updated": "2019-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA004231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Bruce Miller
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• Mary Minter, PT
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• Emily Brook Mooney, MA, APC
• Rodney Moore, MD
• Yuliana Morales-Valencia

• Physical Therapy Assistant in Blue Ridge, GA
• Providers in Blue Ridge, GA by specialty
• Physical Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.