Healthcare Provider Details

I. General information

NPI: 1568405280
Provider Name (Legal Business Name): ALAN MITCHELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E BROAD ST
SAVANNAH GA
31401-2917
US

IV. Provider business mailing address

106 E BROAD ST
SAVANNAH GA
31401-2917
US

V. Phone/Fax

Practice location:
  • Phone: 912-527-1000
  • Fax: 912-527-1153
Mailing address:
  • Phone: 912-527-1000
  • Fax: 912-527-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number59564
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number59564
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: