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General NPI Number Information
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NPI Number | 1366785560
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Entity Type | Organization
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Legal Business Name | MITCHELLS PEDIATRICS LLC
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Dates
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Enumeration Date | 04/05/2013
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Last Update Date | 08/13/2015
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Provider Practice Location Address
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Address Line | 221 PECAN PARK AVE
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City | ALEXANDRIA
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State | LA
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Zip | 71303-3361
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Country | US
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Telephone | 318-487-1602
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Fax | 318-487-1603
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Provider Business Mailing Address
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Address Line | 221 PECAN PARK AVE
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City | ALEXANDRIA
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State | LA
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Zip | 71303-3361
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Country | US
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Telephone | 318-487-1602
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Fax | 318-487-1603
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Authorized Official
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Title or Position | OWNER, PHYSICIAN
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Name | MARCIA MITCHELL
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Credential | MD
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Telephone | 318-487-1602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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