Organization
CHARLES A. MITCHELL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES A MITCHELL JR. MD (OWNER)
(615) 443-4112
Entity
Organization
Contact information
Practice address
206 BABB DR # B, LEBANON, TN 37087-2508
(615) 443-4112
(615) 443-4180
Mailing address
206 BABB DR # B, LEBANON, TN 37087-2508
(615) 443-4112
(615) 443-4180
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD7104
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SOCIAL SECURITY #
TN
01
—
1063409845
CHARLES MITCHELL MD NPI
TN
01
—
1245238567
C. AUSTIN MITCHELL MD NPI
TN
01
—
78775
BLUE CROSS PROVIDER #
TN
Enumeration date
12/18/2006
Last updated
05/21/2020
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