Provider Demographics
NPI:1588720601
Name:MITCHELL, PATSY (DO)
Entity type:Individual
Prefix:DR
First Name:PATSY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 NORTHPARK DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-2111
Mailing Address - Country:US
Mailing Address - Phone:912-268-4994
Mailing Address - Fax:912-434-9096
Practice Address - Street 1:118 NORTHPARK DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-2111
Practice Address - Country:US
Practice Address - Phone:912-264-4994
Practice Address - Fax:912-434-9096
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116805207Q00000X
GA64606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I089701OtherPTAN NUMBER 202I089701