Healthcare Provider Details

I. General information

NPI: 1780621532
Provider Name (Legal Business Name): JAMES M MITCHELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ALCORN DR
CORINTH MS
38834-9368
US

IV. Provider business mailing address

310 ARROWHEAD DR
FULTON MS
38843-6265
US

V. Phone/Fax

Practice location:
  • Phone: 662-293-1175
  • Fax: 662-293-4323
Mailing address:
  • Phone: 662-585-3900
  • Fax: 662-293-4323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number10490
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: