Provider Demographics
NPI:1912000142
Name:MITCHELL, MANDY L (MD)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:L
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2047
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-2047
Mailing Address - Country:US
Mailing Address - Phone:864-512-4500
Mailing Address - Fax:864-512-4505
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:SUITE 4500
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-512-4500
Practice Address - Fax:864-512-4505
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC17347207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC173476Medicaid
SCG57197Medicare UPIN
SC173476Medicaid