Provider Demographics
NPI:1417963026
Name:MITCHELL, SCOTT CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:CHRISTOPHER
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 HAMMOND DR NE
Mailing Address - Street 2:UNIT 329
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-7169
Mailing Address - Country:US
Mailing Address - Phone:404-783-9384
Mailing Address - Fax:
Practice Address - Street 1:60 MILLENNIUM CIR
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2775
Practice Address - Country:US
Practice Address - Phone:706-937-2099
Practice Address - Fax:706-937-4062
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056212207Q00000X
NC200101250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA155005585BOtherMEDICAID QC
GA155005585COtherMEDICAID PCN
GA511I080261OtherMEDICARE PIN PCN
GA056212OtherGEORGIA LICENSE
GA511I080260OtherMEDICARE PIN QUICK CARE