Provider Demographics
NPI:1518329952
Name:MITCHAM, ELIJAH HARMON (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIJAH
Middle Name:HARMON
Last Name:MITCHAM
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 1:720 GALLATIN ST SW STE 500
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4418
Mailing Address - Country:US
Mailing Address - Phone:256-551-6510
Mailing Address - Fax:256-551-6507
Practice Address - Street 1:720 GALLATIN ST SW STE 500
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4418
Practice Address - Country:US
Practice Address - Phone:256-551-6510
Practice Address - Fax:256-551-6507
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.44731207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC397966Medicaid