MEDICARE: CARL I. MITCHELL, MD, PA

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	261QP2300X	Primary Care Clinic/Center	8063	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831370857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARL I. MITCHELL, MD, PA

Provider Business Mailing Address
First Line	:	1 WINDSOR CV STE 301
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-1833
Country	:	US
Telephone Number	:	803-736-4050
Fax Number	:	803-736-4083

Provider Business Practice Location Address
First Line	:	1 WINDSOR CV STE 301
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-1833
Country	:	US
Telephone Number	:	803-736-4050
Fax Number	:	803-736-4083

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. CARL ISSAC MITCHELL
Credential	:	M.D.
Telephone Number	:	803-736-4050

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	12/18/2024

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