Provider Demographics
NPI:1912219296
Name:MITCHELL, JEFFREY L II (DPM)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:MITCHELL
Suffix:II
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:1909 MALLORY LN STE 100
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8230
Practice Address - Country:US
Practice Address - Phone:615-814-0885
Practice Address - Fax:615-814-0056
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN812213ES0103X
IL016005511213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ025468Medicaid
IL016005511OtherILLINOIS STATE LICENSE NUMBER