Provider Demographics
NPI:1770542813
Name:MITCHELL-SAMON, LEVONNE MARIE (MD)
Entity type:Individual
Prefix:MS
First Name:LEVONNE
Middle Name:MARIE
Last Name:MITCHELL-SAMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 THOMASVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-9671
Mailing Address - Country:US
Mailing Address - Phone:743-229-3300
Mailing Address - Fax:743-229-3324
Practice Address - Street 1:3049 THOMASVILLE ROAD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-9671
Practice Address - Country:US
Practice Address - Phone:743-229-3300
Practice Address - Fax:743-229-3324
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82607207R00000X, 207RI0200X
NC2022-03272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000951772AMedicaid
FL15390OtherBCBS
FL1770542813OtherTRICARE
FL264595500Medicaid
GA000951772AMedicaid
FL1770542813OtherTRICARE