Provider Demographics
NPI:1093362972
Name:MITCHELL, WILLIAM DOLAN
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DOLAN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 10TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-3602
Mailing Address - Country:US
Mailing Address - Phone:706-984-7400
Mailing Address - Fax:
Practice Address - Street 1:1900 10TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3602
Practice Address - Country:US
Practice Address - Phone:706-984-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-24
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA103752208600000X
LA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty