Provider Demographics
NPI:1194756676
Name:MITCHELL, ROBERT LACOUR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LACOUR
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1584 TIMBERLAND RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-4163
Mailing Address - Country:US
Mailing Address - Phone:404-633-1261
Mailing Address - Fax:
Practice Address - Street 1:1266 HIGHWAY 515 S
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143
Practice Address - Country:US
Practice Address - Phone:706-692-2441
Practice Address - Fax:706-301-5352
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047491208M00000X, 207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00318977OtherRAILROAD MEDICARE
GA000855324MMedicaid
GA000855324MMedicaid
GAP00318977OtherRAILROAD MEDICARE