Provider Demographics
NPI:1376540419
Name:MITCHELL, CAROL JEAN (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:MITCHELL
Suffix:
Gender:F
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:PO BOX 1000
Mailing Address - Street 2:DEPT 978
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148
Mailing Address - Country:US
Mailing Address - Phone:901-756-5565
Mailing Address - Fax:901-756-5564
Practice Address - Street 1:6401 POPLAR AVENUE
Practice Address - Street 2:#400
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-525-3086
Practice Address - Fax:901-969-1113
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3429717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4293970OtherBCBS
TNA99472Medicare UPIN
TN103I114149Medicare PIN