Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD010288 | TN |
NPI | 1073507356 |
---|---|
Provider Name | Dr. Foy Burton Mitchell JR. |
First Address | Knoxville, TN 37919-7360 |
Second Address | Athens, TN 37303-3495 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2005 |
Last Update Date | 13/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040001231 | MC RAILROAD-PALMETTO GBA (01) | TN |
D70072 | (02) | TN |