Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 035297 | GA |
Y | 208600000X | Surgeon | 035297 | GA |
N | 2082S0105X | Plastic Hand Surgeon | 035297 | GA |
N | 2086S0122X | Plastic and Reconstructive Surgery | 035297 | GA |
NPI | 1912913609 |
---|---|
Provider Name | Charles W. Mitchell |
First Address | Brunswick, GA 31520-4265 |
Second Address | Brunswick, GA 31520-4265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 28/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000908146A | (05) | GA |
G59045 | (02) | GA |