Provider Demographics
NPI:1275081218
Name:MITCHELL, JAMIE LEE (PA)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:LEE
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:706-774-7263
Mailing Address - Fax:706-774-7230
Practice Address - Street 1:840 STEVENS CREEK RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-9251
Practice Address - Country:US
Practice Address - Phone:706-722-6957
Practice Address - Fax:706-722-1999
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2018-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA8278363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant