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Organization

MITCHUM MEDICAL CLINIC, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. OTIS DALE MITCHUM M.D. (PRESIDENT/PHYSICIAN)
(334) 684-9400
Entity
Organization

Contact information

Practice address
100 W LAKE PROFESSIONAL PARK, GENEVA, AL 36340-1203
(334) 684-9400
(334) 684-6262
Mailing address
100 W LAKE PROFESSIONAL PARK, GENEVA, AL 36340-1203
(334) 684-9400
(334) 684-6262

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2656
AL

Other

Enumeration date
08/17/2006
Last updated
09/20/2007
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