Provider Demographics
NPI:1598879686
Name:MITCHELL, LAUREN SUE (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:SUE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 WALNUT RUN RD
Mailing Address - Street 2:
Mailing Address - City:CORDOUA
Mailing Address - State:TN
Mailing Address - Zip Code:38018
Mailing Address - Country:US
Mailing Address - Phone:901-757-3550
Mailing Address - Fax:901-757-3549
Practice Address - Street 1:8110 WALNUT RUN RD
Practice Address - Street 2:
Practice Address - City:CORDOUA
Practice Address - State:TN
Practice Address - Zip Code:38018
Practice Address - Country:US
Practice Address - Phone:901-754-9600
Practice Address - Fax:901-757-3554
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN032115208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H17415Medicare UPIN