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General NPI Number Information
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NPI Number | 1861555419
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Entity Type | Organization
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Legal Business Name | CHARLES A. MITCHELL
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 206 BABB DR # B
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City | LEBANON
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State | TN
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Zip | 37087-2508
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Country | US
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Telephone | 615-443-4112
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Fax | 615-443-4180
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Provider Business Mailing Address
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Address Line | 206 BABB DR # B
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City | LEBANON
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State | TN
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Zip | 37087-2508
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Country | US
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Telephone | 615-443-4112
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Fax | 615-443-4180
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES A MITCHELL JR.
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Credential | MD
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Telephone | 615-443-4112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD7104
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License Number State | TN
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