Provider Demographics
NPI:1447219548
Name:MITCHELL, DANIEL F
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:F
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W HILL ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6618
Mailing Address - Country:US
Mailing Address - Phone:229-225-1900
Mailing Address - Fax:229-225-3493
Practice Address - Street 1:119 W HILL ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6618
Practice Address - Country:US
Practice Address - Phone:229-225-1900
Practice Address - Fax:229-225-3493
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043430207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA07BBCRPMedicare PIN
GAE90424Medicare UPIN