Provider Demographics
NPI:1669485967
Name:MITCHELL, GEORGE LEWIS JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LEWIS
Last Name:MITCHELL
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 RIVERBEND DR.
Mailing Address - Street 2:SUITE A
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-2556
Mailing Address - Country:US
Mailing Address - Phone:256-547-5471
Mailing Address - Fax:256-546-0564
Practice Address - Street 1:819 RIVERBEND DR.
Practice Address - Street 2:STE. A
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-2556
Practice Address - Country:US
Practice Address - Phone:256-547-5471
Practice Address - Fax:256-546-0564
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL94752OtherBC/BS PROVIDER #