Provider Demographics
NPI:1164426151
Name:MITCHELL, C CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:C
Middle Name:CRAIG
Last Name:MITCHELL
Suffix:
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 1:425 W 3RD AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1941
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 W 3RD AVE
Practice Address - Street 2:STE 101
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1985
Practice Address - Country:US
Practice Address - Phone:229-312-5800
Practice Address - Fax:229-312-5853
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA21027174400000X
GA021027207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD47093Medicare UPIN