Provider Demographics
NPI:1912913609
Name:MITCHELL, CHARLES W (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2500 STARLING ST
Mailing Address - Street 2:SUITE 603
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4265
Mailing Address - Country:US
Mailing Address - Phone:912-280-9977
Mailing Address - Fax:912-280-9995
Practice Address - Street 1:2500 STARLING ST
Practice Address - Street 2:SUITE 603
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4265
Practice Address - Country:US
Practice Address - Phone:912-280-9977
Practice Address - Fax:912-280-9995
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0352972082S0099X, 2082S0105X, 2086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000908146AMedicaid
GA000908146AMedicaid
GA24BCBSCMedicare ID - Type Unspecified