Healthcare Provider Details

I. General information

NPI: 1215212543
Provider Name (Legal Business Name): BOBBY MITCHELL M.SC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BJ MITCHELL M.SC.

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9228 VOLLMERHAUSEN RD
JESSUP MD
20794-9518
US

IV. Provider business mailing address

PO BOX 507
SAVAGE MD
20763-0507
US

V. Phone/Fax

Practice location:
  • Phone: 240-422-2123
  • Fax:
Mailing address:
  • Phone: 240-422-2123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: