MEDICARE: DAVIN MITCHELL 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	63786	GA

General Provider Information

NPI Number	:	1861669517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVIN MITCHELL M.D.

Provider Business Mailing Address
First Line	:	1075 LAFAYETTE PKWY
Second Line	:	STE 100
City	:	LAGRANGE
State	:	GA
Zip	:	30241-3584
Country	:	US
Telephone Number	:	706-593-3256
Fax Number	:	706-443-5275

Provider Business Practice Location Address
First Line	:	1075 LAFAYETTE PKWY
Second Line	:	STE 100
City	:	LAGRANGE
State	:	GA
Zip	:	30241-3584
Country	:	US
Telephone Number	:	706-593-3256
Fax Number	:	706-443-5275

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

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	08/08/2016

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