MEDICARE: DR. PHILLIP ANTHONY MITCHELL D.M.D, M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	03787	AL
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	17041	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06576	OTHER	AL	BCBS # OF AL

General Provider Information

NPI Number	:	1053325167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP ANTHONY MITCHELL D.M.D, M.D.

Provider Business Mailing Address
First Line	:	5511 HIGHWAY 280
Second Line	:	SUITE 118
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-6585
Country	:	US
Telephone Number	:	205-980-9000
Fax Number	:	205-980-1399

Provider Business Practice Location Address
First Line	:	5511 HIGHWAY 280
Second Line	:	SUITE 118
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-6585
Country	:	US
Telephone Number	:	205-980-9000
Fax Number	:	205-980-1399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	09/11/2025

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Directions to “ DR. PHILLIP ANTHONY MITCHELL D.M.D, M.D.” Practice Location

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