Healthcare Provider Details

I. General information

NPI: 1568816601
Provider Name (Legal Business Name): JAMES EUGENE MITCHELL IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 11/22/2025
Certification Date: 11/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 N NORTHHILLS BLVD
FAYETTEVILLE AR
72703-4424
US

IV. Provider business mailing address

1 HARRY S TRUMAN DR
LARGO MD
20774-1033
US

V. Phone/Fax

Practice location:
  • Phone: 479-463-1000
  • Fax:
Mailing address:
  • Phone: 240-677-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101283071
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberD0098644
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0098644
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0098644
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: