| Doctor Name: | MICHELLE MOCK |
| NPI Number: | 1538346598 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | RN106941 |
| Business Practice Address: | 12799 Magnolia St Blakely, GA - 398232315 |
| Business Phone Number: | 2292742206 |
| Business Fax Number: | |
| Mailing Address: | 1120 W Broad Ave # A, ALBANY |
| State: | GA |
| Postal Code: | 317074397 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 01/22/2008 |
| NPI Last Update Date: | 02/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0808X |
| License Number: | RN106941 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |