Healthcare Provider Details

I. General information

NPI: 1699579243
Provider Name (Legal Business Name): ANDREW WILSON MITCHELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 UNIVERSITY HOSPITAL DR. 212 MASTIN PATIENT CARE CENTER
MOBILE AL
36617
US

IV. Provider business mailing address

2451 UNIVERSITY HOSPITAL DR. 212 MASTIN PATIENT CARE CENTER
MOBILE AL
36617
US

V. Phone/Fax

Practice location:
  • Phone: 251-445-8282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL.6612
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: