Provider Demographics
NPI:1710986310
Name:MITCHELL, CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:M
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:496 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1827
Mailing Address - Country:US
Mailing Address - Phone:859-288-2425
Mailing Address - Fax:859-288-7510
Practice Address - Street 1:1640 BRYAN STATION RD STE 1
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-2144
Practice Address - Country:US
Practice Address - Phone:859-288-2425
Practice Address - Fax:859-721-3918
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64253271Medicaid
KY64253271Medicaid
KYK058100Medicare PIN