Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CHIROO5562 | GA |
NPI | 1417091471 |
---|---|
Provider Name | Benjamin Caughey Mitchell |
First Address | Dacula, GA 30019-1667 |
Second Address | Dacula, GA 30019-1667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 19/08/2019 |