Healthcare Provider Details

I. General information

NPI: 1255445367
Provider Name (Legal Business Name): STEPHEN ROBERT MITCHELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HOSPITAL DRIVE
PARIS TN
38242-4504
US

IV. Provider business mailing address

PO BOX 1178
PARIS TN
38242
US

V. Phone/Fax

Practice location:
  • Phone: 615-444-2320
  • Fax: 615-449-3163
Mailing address:
  • Phone: 615-444-2320
  • Fax: 615-449-3163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number19456
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: