Provider Demographics
NPI:1881743672
Name:MITCHUM, PATRICIA ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANNE
Last Name:MITCHUM
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 1:10120 SR 56
Mailing Address - Street 2:
Mailing Address - City:COALMONT
Mailing Address - State:TN
Mailing Address - Zip Code:37313-2505
Mailing Address - Country:US
Mailing Address - Phone:931-779-4002
Mailing Address - Fax:931-779-4003
Practice Address - Street 1:10120 SR 56
Practice Address - Street 2:
Practice Address - City:COALMONT
Practice Address - State:TN
Practice Address - Zip Code:37313-2505
Practice Address - Country:US
Practice Address - Phone:931-779-4002
Practice Address - Fax:931-779-4003
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21877207Q00000X
AZ19016208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE45437Medicare UPIN