Provider Demographics
NPI:1578080180
Name:MITCHELL, ALVIN JR
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:
Last Name:MITCHELL
Suffix:JR
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 1:10 BREEZEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-2901
Mailing Address - Country:US
Mailing Address - Phone:803-363-9674
Mailing Address - Fax:803-509-8210
Practice Address - Street 1:10 BREEZEWOOD COURT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212
Practice Address - Country:US
Practice Address - Phone:803-363-9674
Practice Address - Fax:803-509-8210
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2017-54189-53078343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
814420717OtherNON EMERGENCY MEDICAL TRANSPORTATION