Provider Demographics
NPI:1417091471
Name:MITCHELL, BENJAMIN CAUGHEY (DC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:CAUGHEY
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2098 TERON TRCE
Mailing Address - Street 2:STE 300
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1667
Mailing Address - Country:US
Mailing Address - Phone:706-654-0142
Mailing Address - Fax:
Practice Address - Street 1:2098 TERON TRCE
Practice Address - Street 2:STE 300
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1667
Practice Address - Country:US
Practice Address - Phone:770-614-4060
Practice Address - Fax:678-482-7788
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIROO5562111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCDQCMedicare ID - Type Unspecified
GA6710710001Medicare NSC