Provider Demographics
NPI:1235179003
Name:EARLEY, MITCHELL L (DO)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:L
Last Name:EARLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:1101 BOWMAN RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3213
Practice Address - Country:US
Practice Address - Phone:436-067-1858
Practice Address - Fax:843-606-7187
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3849207Q00000X
SC39879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC398796Medicaid
SC398796Medicaid
SCSC94219223Medicare PIN