Provider Demographics
NPI:1275669491
Name:MITCHELL, JOSEPH RICHARD (SA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:RICHARD
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 ROCKY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY FACE
Mailing Address - State:GA
Mailing Address - Zip Code:30740-9095
Mailing Address - Country:US
Mailing Address - Phone:706-277-2486
Mailing Address - Fax:
Practice Address - Street 1:2631 ROCKY DR
Practice Address - Street 2:
Practice Address - City:ROCKY FACE
Practice Address - State:GA
Practice Address - Zip Code:30740-9095
Practice Address - Country:US
Practice Address - Phone:706-277-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
03-235246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist