Healthcare Provider Details

I. General information

NPI: 1861194797
Provider Name (Legal Business Name): MITCHELL BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18877 JEB STUART HWY
STUART VA
24171-5223
US

IV. Provider business mailing address

APPFAMILY MEDICINE 148 NC-105 EXTENSION, SUITE 102
BOONE NC
26807
US

V. Phone/Fax

Practice location:
  • Phone: 276-694-4466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102210157
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: