Provider Demographics
NPI:1255371787
Name:WILLCUTT, MITCHELL S (PA)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:S
Last Name:WILLCUTT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3056 HEALTHY WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2435
Mailing Address - Country:US
Mailing Address - Phone:205-930-2925
Mailing Address - Fax:
Practice Address - Street 1:2871 ACTON ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2560
Practice Address - Country:US
Practice Address - Phone:205-939-0023
Practice Address - Fax:205-939-4180
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-131363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009955580Medicaid
AL051028560OtherBUE CROSS - 860 MONT RD
AL009932943Medicaid
AL009978910Medicaid
AL051514497OtherBLUE CROSS - 2660 10TH AV
AL051506130OtherBLUE CROSS - 48 MED PARK
AL009932943Medicaid
AL051506130OtherBLUE CROSS - 48 MED PARK