Provider Demographics
NPI:1023762069
Name:MITCHELL, MICHAEL FRANCIS JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:MITCHELL
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:5305 SENECA AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5960
Mailing Address - Country:US
Mailing Address - Phone:901-579-0151
Mailing Address - Fax:
Practice Address - Street 1:795 RIDGE LAKE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-9475
Practice Address - Country:US
Practice Address - Phone:901-255-6532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN4823363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant