Provider Demographics
NPI:1558648147
Name:MITCHELL, JUSTIN CHAYNE (CPHT)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:CHAYNE
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-2924
Mailing Address - Country:US
Mailing Address - Phone:919-623-6008
Mailing Address - Fax:
Practice Address - Street 1:8651 BRIER CREEK PKWY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7325
Practice Address - Country:US
Practice Address - Phone:919-623-6008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146D00000X
NC32086183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant