Healthcare Provider Details

I. General information

NPI: 1861498024
Provider Name (Legal Business Name): GREGORY E MITCHELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 FAIRFIELD DR
NEW ALBANY MS
38652-3107
US

IV. Provider business mailing address

117 FAIRFIELD DR
NEW ALBANY MS
38652-3107
US

V. Phone/Fax

Practice location:
  • Phone: 662-534-0029
  • Fax: 662-534-0008
Mailing address:
  • Phone: 662-534-0029
  • Fax: 662-534-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number17200
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number17200
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: