Provider Demographics
NPI:1831190479
Name:MITCHELL, CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:105 W STONE DR
Practice Address - Street 2:STE 2B
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3256
Practice Address - Country:US
Practice Address - Phone:423-247-7500
Practice Address - Fax:423-245-4679
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD40092207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010240051Medicaid
TN3335127Medicaid
TN3335127Medicare PIN
VAC06181Medicare UPIN
VAMC10364Medicare UPIN
TN103I086169Medicare UPIN
TN0281780001Medicare PIN
H15751Medicare UPIN
TN3335127Medicaid
TNP00291795Medicare PIN
TNC30809Medicare PIN
TN0281780003Medicare PIN
VACA0736Medicare PIN
TN3700592Medicare PIN