Provider Demographics
NPI:1306806930
Name:MITCHELL, SHARON (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 HWY 145 SOUTH
Mailing Address - Street 2:
Mailing Address - City:BALDWYN
Mailing Address - State:MS
Mailing Address - Zip Code:38824
Mailing Address - Country:US
Mailing Address - Phone:662-365-4100
Mailing Address - Fax:662-365-4115
Practice Address - Street 1:745 HWY 145 SOUTH
Practice Address - Street 2:
Practice Address - City:BALDWYN
Practice Address - State:MS
Practice Address - Zip Code:38824
Practice Address - Country:US
Practice Address - Phone:662-365-4100
Practice Address - Fax:662-365-4115
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14088207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116682Medicaid
MS110001287Medicare ID - Type Unspecified
MSF40463Medicare UPIN