Provider Demographics
NPI:1376836254
Name:MITCHELL, WILLIAM RYAN (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RYAN
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 1:1700 TARBORO ST W STE 103
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3481
Mailing Address - Country:US
Mailing Address - Phone:252-399-5304
Mailing Address - Fax:252-399-5305
Practice Address - Street 1:1700 TARBORO ST W STE 103
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3481
Practice Address - Country:US
Practice Address - Phone:252-399-5304
Practice Address - Fax:252-399-5305
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-01588207XX0005X
TN56416207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ037241Medicaid