Healthcare Provider Details

I. General information

NPI: 1306484522
Provider Name (Legal Business Name): PEYTON EDWARD MITCHELL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 ASPEN GROVE DR STE 102
FRANKLIN TN
37067-2841
US

IV. Provider business mailing address

PO BOX 306556
NASHVILLE TN
37230-6556
US

V. Phone/Fax

Practice location:
  • Phone: 615-771-1116
  • Fax: 615-771-1114
Mailing address:
  • Phone: 615-329-2294
  • Fax: 615-695-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4199
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: