Basic Information
| Provider Information | |||||||||
| NPI: | 1770577629 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROVES | ||||||||
| FirstName: | MITZI | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 741331 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303741331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134690503 | ||||||||
| FaxNumber: | 9134695267 | ||||||||
| Practice Location | |||||||||
| Address1: | 15101 GLENWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | STANLEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662233154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136818866 | ||||||||
| FaxNumber: | 9133381311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 01/26/2022 | ||||||||
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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 | 207Q00000X | 05-31268 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.