Individual
MARY MORGAN MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
1691 INNOVATION DR STE 2100, BLACKSBURG, VA 24060-6618
(540) 232-8405
Mailing address
PO BOX 1088, PULASKI, VA 24301-1088
(540) 980-0922
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0102205725
VA
207Q00000X
Family Medicine Physician
5101022404
MI
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
0102205725
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/23/2016
Last updated
01/13/2020
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