Provider Demographics
NPI:1427210723
Name:MITCHELL, CAROLYN A
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239B N MCQUEEN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-2501
Mailing Address - Country:US
Mailing Address - Phone:843-662-2902
Mailing Address - Fax:843-662-6964
Practice Address - Street 1:239B N MCQUEEN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-2501
Practice Address - Country:US
Practice Address - Phone:843-662-2902
Practice Address - Fax:843-662-6964
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2548Medicaid
SCDE2548Medicaid