Basic Information
| Provider Information | |||||||||
| NPI: | 1013968080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10151 DEERWOOD PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322560566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044176225 | ||||||||
| FaxNumber: | 4103284124 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 S GREENE ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103286704 | ||||||||
| FaxNumber: | 4103284124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 09/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 024342 | LA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 057221 | GA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207RC0200X | 057221 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RC0200X | 024342 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RC0200X | D69403 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207P00000X | D69403 | MD | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 361896 | 01 | GA | WELLCARE | OTHER | 419682100 | 05 | MD | MEDICAID | 52173131 | 01 | GA | BCBS | OTHER | 342360871A | 05 | GA | MEDICAID | 0137 | 01 | GA | BLUE CROSS | OTHER | 342360871B | 05 | GA | MEDICAID | 0137 | 01 | MD | BLUE CROSS | OTHER | P00334342 | 01 | GA | RAILRAOD MEDICARE | OTHER |