Healthcare Provider Details

I. General information

NPI: 1164426151
Provider Name (Legal Business Name): C CRAIG MITCHELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W 3RD AVE STE 101
ALBANY GA
31701-1985
US

IV. Provider business mailing address

425 W 3RD AVE SUITE 600
ALBANY GA
31701-1941
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-5800
  • Fax: 229-312-5853
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number21027
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number021027
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: