Provider Demographics
NPI:1740855121
Name:MITCHELL, ALBERT III
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:MITCHELL
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 SOUTH CLARK STREET
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202
Mailing Address - Country:US
Mailing Address - Phone:844-381-4432
Mailing Address - Fax:877-763-2165
Practice Address - Street 1:2611 SOUTH CLARK STREET
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202
Practice Address - Country:US
Practice Address - Phone:844-381-4432
Practice Address - Fax:877-763-2165
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant