Provider Demographics
NPI:1083728778
Name:MITCHELL, BENJAMIN T III (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:T
Last Name:MITCHELL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-2509
Mailing Address - Country:US
Mailing Address - Phone:843-487-1582
Mailing Address - Fax:843-487-1585
Practice Address - Street 1:301 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2509
Practice Address - Country:US
Practice Address - Phone:843-487-1582
Practice Address - Fax:843-487-1585
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16983207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCL15277Medicaid
SCF87696Medicare UPIN
SCF876964784Medicare ID - Type Unspecified