Healthcare Provider Details

I. General information

NPI: 1326098237
Provider Name (Legal Business Name): GREGORY CHARLES MITCHELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 ENOCH BLVD
SAVANNAH TN
38372-2240
US

IV. Provider business mailing address

P.O. BOX 655
SAVANNAH TN
38372-0655
US

V. Phone/Fax

Practice location:
  • Phone: 731-925-2300
  • Fax:
Mailing address:
  • Phone: 731-925-2300
  • Fax: 731-925-3506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30768
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: