Provider Demographics
NPI:1750275327
Name:MITCHELL, MARTHA D
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:D
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 THOMASVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-7043
Mailing Address - Country:US
Mailing Address - Phone:336-695-4306
Mailing Address - Fax:
Practice Address - Street 1:4405 THOMASVILLE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-7043
Practice Address - Country:US
Practice Address - Phone:336-695-4306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty