Healthcare Provider Details

I. General information

NPI: 1083283915
Provider Name (Legal Business Name): JARED MITCHELL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 HARPER ST STE B
AUGUSTA GA
30901-0619
US

IV. Provider business mailing address

1430 HARPER ST STE B
AUGUSTA GA
30901-0619
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-5451
  • Fax:
Mailing address:
  • Phone: 706-724-5451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER FINLEY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 706-724-5451