MEDICARE: DR. GEORGE D MITCHELL MD

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	207RC0000X	Cardiovascular Disease Physician	G46366	CA

General Provider Information

NPI Number	:	1538161658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE D MITCHELL MD

Provider Business Mailing Address
First Line	:	319 CORNELIA AVE
Second Line	:
City	:	LODI
State	:	CA
Zip	:	95242-8806
Country	:	US
Telephone Number	:	805-218-9397
Fax Number	:	805-218-9397

Provider Business Practice Location Address
First Line	:	319 CORNELIA AVE
Second Line	:
City	:	LODI
State	:	CA
Zip	:	95242-8806
Country	:	US
Telephone Number	:	805-218-9397
Fax Number	:	805-218-9397

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	11/15/2022

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