1245238567 NPI number — DR. CHARLES AUSTIN MITCHELL III M.D.

Table of content: BETSY PARSONS (NPI 1922371145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245238567 NPI number — DR. CHARLES AUSTIN MITCHELL III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
CHARLES
Provider Middle Name:
AUSTIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245238567
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5505 EDMONDSON PIKE
Provider Second Line Business Mailing Address:
10
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37211-5872
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-810-8730
Provider Business Mailing Address Fax Number:
615-810-8731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5505 EDMONDSON PIKE
Provider Second Line Business Practice Location Address:
10
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37211-5872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-810-8730
Provider Business Practice Location Address Fax Number:
615-810-8731
Provider Enumeration Date:
07/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  37546 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2075994 . This is a "CIGNA PIN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 810600182 . This is a "GREAT WEST HEALTHCARE PIN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 810600182 . This is a "SIGNATURE HEALTH ALLIANCE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 810600182 . This is a "PHCS NETWORK PIN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 810600182 . This is a "UNITED HEALTHCARE PIN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4066881 . This is a "BLUE CROSS PIN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: H84577 . This is a "HEALTHSPRING PIN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3885689 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7961488 . This is a "AETNA PIN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 810600182 . This is a "ONE HEALTH PLAN, INC PIN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 2130841 . This is a "FIRST HEALTH NETWORK PIN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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