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General NPI Number Information
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NPI Number | 1780518910
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Entity Type | Organization
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Legal Business Name | WIDERCARE COMMUNITY HEALTH OF NEW JERSEY PC
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Dates
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Enumeration Date | 06/11/2026
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Last Update Date | 06/11/2026
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Provider Practice Location Address
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Address Line | 317 GEORGE ST STE 320
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-2091
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Country | US
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Telephone | 323-776-3632
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Fax |
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Provider Business Mailing Address
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Address Line | 1303 PENDLETON ST SE
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City | ATLANTA
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State | GA
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Zip | 30316-3801
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILLIP A MITCHELL
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Credential | MD
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Telephone | 720-480-9613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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