Healthcare Provider Details

I. General information

NPI: 1144293457
Provider Name (Legal Business Name): JAMIE ALAN MITCHELL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 W WASHINGTON ST
MONTICELLO GA
31064
US

IV. Provider business mailing address

PO BOX 229
MONTICELLO GA
31064
US

V. Phone/Fax

Practice location:
  • Phone: 706-468-6394
  • Fax: 706-468-8113
Mailing address:
  • Phone: 706-468-6394
  • Fax: 706-468-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10912
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: