Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 20178 | MS |
N | 2084N0400X | Neurologist | 26872 | AL |
NPI | 1043427834 |
---|---|
Provider Name | Michael Byron Mitchell |
First Address | Hattiesburg, MS 39401-7246 |
Second Address | Picayune, MS 39466-5577 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 23/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06902001 | (05) | MS |
1365173 | (05) | LA |
9277184 | AETNA (01) | MS |