MEDICARE: DR. C CRAIG MITCHELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	21027	GA
2	207RC0000X	Cardiovascular Disease Physician	021027	GA

General Provider Information

NPI Number	:	1164426151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. C CRAIG MITCHELL M.D.

Provider Business Mailing Address
First Line	:	425 W 3RD AVE
Second Line	:	SUITE 600
City	:	ALBANY
State	:	GA
Zip	:	31701-1941
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W 3RD AVE
Second Line	:	STE 101
City	:	ALBANY
State	:	GA
Zip	:	31701-1985
Country	:	US
Telephone Number	:	229-312-5800
Fax Number	:	229-312-5853

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	12/27/2011

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