Healthcare Provider Details

I. General information

NPI: 1962430074
Provider Name (Legal Business Name): ELIZABETH WYATT MITCHELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BAPTIST DR STE 220
MADISON MS
39110-2031
US

IV. Provider business mailing address

501 BAPTIST DR STE 220
MADISON MS
39110-2031
US

V. Phone/Fax

Practice location:
  • Phone: 601-985-9120
  • Fax: 601-985-9122
Mailing address:
  • Phone: 601-985-9120
  • Fax: 601-985-9122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number13902
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: