Healthcare Provider Details

I. General information

NPI: 1952983769
Provider Name (Legal Business Name): MITCHELL EVAN TEMPLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 PEACHTREE DUNWOODY RD
SANDY SPRINGS GA
30342-1764
US

IV. Provider business mailing address

1041 CARROLLTON AVE APT D
METAIRIE LA
70005-2355
US

V. Phone/Fax

Practice location:
  • Phone: 678-843-7001
  • Fax:
Mailing address:
  • Phone: 781-910-6147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number113036
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number326378
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: