Healthcare Provider Details

I. General information

NPI: 1861669517
Provider Name (Legal Business Name): DAVIN MITCHELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 LAFAYETTE PKWY STE 100
LAGRANGE GA
30241-3584
US

IV. Provider business mailing address

1075 LAFAYETTE PKWY STE 100
LAGRANGE GA
30241-3584
US

V. Phone/Fax

Practice location:
  • Phone: 706-593-3256
  • Fax: 706-443-5275
Mailing address:
  • Phone: 706-593-3256
  • Fax: 706-443-5275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number63786
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: