Provider Demographics
NPI:1861555419
Name:CHARLES A. MITCHELL
Entity type:Organization
Organization Name:CHARLES A. MITCHELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:615-443-4112
Mailing Address - Street 1:206 BABB DR # B
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2508
Mailing Address - Country:US
Mailing Address - Phone:615-443-4112
Mailing Address - Fax:615-443-4180
Practice Address - Street 1:206 BABB DR # B
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2508
Practice Address - Country:US
Practice Address - Phone:615-443-4112
Practice Address - Fax:615-443-4180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD7104207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1245238567OtherC. AUSTIN MITCHELL MD NPI
TN$$$$$$$$$OtherSOCIAL SECURITY #
TN78775OtherBLUE CROSS PROVIDER #
TN1063409845OtherCHARLES MITCHELL MD NPI
TN3182181Medicare PIN
TN3373361Medicare PIN
TN3373361Medicare ID - Type UnspecifiedGROUP PROVIDER #
TN3885687Medicare ID - Type UnspecifiedC. AUSTIN MITCHELL #
TN1245238567OtherC. AUSTIN MITCHELL MD NPI
TN3671645Medicare ID - Type UnspecifiedBARBARA WOLFF PAC #