Healthcare Provider Details

I. General information

NPI: 1326156563
Provider Name (Legal Business Name): PAUL G MITCHELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5385 PEACHTREE DUNWOODY RD
ATLANTA GA
30342-2163
US

IV. Provider business mailing address

5385 PEACHTREE DUNWOODY RD
ATLANTA GA
30342-2163
US

V. Phone/Fax

Practice location:
  • Phone: 239-261-4404
  • Fax: 239-280-5998
Mailing address:
  • Phone: 239-261-4404
  • Fax: 239-280-5998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME74819
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number075473
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: