Provider Demographics
NPI:1255626560
Name:MITCHELL, MICAH JAMES (MBA, ATP)
Entity type:Individual
Prefix:MR
First Name:MICAH
Middle Name:JAMES
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MBA, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 SKYWAY CIR N
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3509
Mailing Address - Country:US
Mailing Address - Phone:817-716-1725
Mailing Address - Fax:
Practice Address - Street 1:2930 SKYWAY CIR N
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3509
Practice Address - Country:US
Practice Address - Phone:817-716-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXATP3302247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other