Provider Demographics
NPI:1831356898
Name:MITCHELL, MEREDITH E (MD)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:E
Last Name:MITCHELL
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 1:75 BAYLOR DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-8965
Mailing Address - Country:US
Mailing Address - Phone:843-540-5857
Mailing Address - Fax:843-524-5655
Practice Address - Street 1:75 BAYLOR DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8965
Practice Address - Country:US
Practice Address - Phone:843-540-5857
Practice Address - Fax:843-524-5655
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL30744174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC307448Medicaid
SCAA27428067Medicare UPIN