Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD10287 | TN |
Y | 208600000X | Surgeon | MD10287 | TN |
NPI | 1013019322 |
---|---|
Provider Name | Dr. Charles Stone Mitchell |
First Address | Knoxville, TN 37950-2948 |
Second Address | Knoxville, TN 37919-4858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 03/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3194349 | (05) | TN |
B04593 | (02) |