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General NPI Number Information
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NPI Number | 1801997218
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Entity Type | Individual
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Provider Name | DALE G MITCHUM MD
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Gender | Male
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 100 W LAKE PROFESSIONAL PARK STE 2
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City | GENEVA
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State | AL
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Zip | 36340-1200
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Country | US
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Telephone | 334-684-3007
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Fax | 334-684-3059
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Provider Business Mailing Address
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Address Line | PO BOX 900
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City | GENEVA
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State | AL
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Zip | 36340-0900
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Country | US
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Telephone | 334-684-3007
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Fax | 334-684-3059
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 12381
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License Number State | AL
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