Provider Demographics
NPI:1225297476
Name:MITCHELL, DON Q (M D)
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:Q
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N STATE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1689
Mailing Address - Country:US
Mailing Address - Phone:601-354-4836
Mailing Address - Fax:601-354-2619
Practice Address - Street 1:1600 N STATE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1689
Practice Address - Country:US
Practice Address - Phone:601-354-4836
Practice Address - Fax:601-354-2619
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0018765Medicaid
MS0030000005Medicare NSC
MS0018765Medicaid