Provider Demographics
NPI:1699773531
Name:MITCHELL, WILLIAM CRAIG (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CRAIG
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 HEALTH PARK DR FL HP2
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4692
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:
Practice Address - Street 1:1315 2ND ST SW
Practice Address - Street 2:SUITE 202
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4944
Practice Address - Country:US
Practice Address - Phone:540-344-3020
Practice Address - Fax:540-344-4394
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042794207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1699773531Medicaid
1831141597OtherNPI GROUP
VA5831563Medicaid
VA1699773531Medicaid
VAF78257Medicare UPIN