Basic Information
| Provider Information | |||||||||
| NPI: | 1386656916 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4048 E US HIGHWAY 64 ALT | ||||||||
| Address2: | PHYSICIANS OFFICE BUILDING SUITE 1 | ||||||||
| City: | MURPHY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 289066968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288378131 | ||||||||
| FaxNumber: | 8288377687 | ||||||||
| Practice Location | |||||||||
| Address1: | 4188 E US HIGHWAY 64 | ||||||||
| Address2: | PHYSICIANS BUILDING SUITE 1 | ||||||||
| City: | MURPHY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 289066856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288378131 | ||||||||
| FaxNumber: | 8288377687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 12/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 21208 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00186997A | 05 | GA | MEDICAID | 8959545 | 05 | NC | MEDICAID |