Provider Demographics
NPI:1821077793
Name:MITCHELL, ERIC S (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
Last Name:MITCHELL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:775 POPLAR RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-8300
Mailing Address - Country:US
Mailing Address - Phone:770-253-0611
Mailing Address - Fax:770-502-0521
Practice Address - Street 1:775 POPLAR RD
Practice Address - Street 2:SUITE 230
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-8300
Practice Address - Country:US
Practice Address - Phone:770-253-0611
Practice Address - Fax:770-502-0521
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2015-11-05
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Provider Licenses
StateLicense IDTaxonomies
GA46177207RC0000X
GA046177207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA857858919ABCDEFMedicaid
GA20206I6089Medicare PIN