Provider Demographics
NPI:1831370857
Name:CARL I. MITCHELL, MD, PA
Entity type:Organization
Organization Name:CARL I. MITCHELL, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:ISSAC
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-736-4050
Mailing Address - Street 1:1 WINDSOR CV STE 301
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-1833
Mailing Address - Country:US
Mailing Address - Phone:803-736-4050
Mailing Address - Fax:803-736-4083
Practice Address - Street 1:1 WINDSOR CV STE 301
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-1833
Practice Address - Country:US
Practice Address - Phone:803-736-4050
Practice Address - Fax:803-736-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8063261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3505Medicaid
SC4033Medicare PIN
SCC60995Medicare UPIN