Individual
DR. ROBERT LACOUR MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1266 HIGHWAY 515 S, JASPER, GA 30143
(706) 692-2441
(706) 301-5352
Mailing address
1584 TIMBERLAND RD NE, ATLANTA, GA 30345-4163
(404) 633-1261
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
047491
GA
207R00000X
Internal Medicine Physician
Primary
047491
GA
208M00000X
Hospitalist Physician
047491
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000855324M
—
GA
01
—
P00318977
RAILROAD MEDICARE
GA
Enumeration date
07/05/2006
Last updated
07/09/2020
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