Basic Information
Provider Information | |||||||||
NPI: | 1730263195 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MITCHELL-WILLIAMS | ||||||||
FirstName: | JOCELYN | ||||||||
MiddleName: | A | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3 COOPER PLZ | ||||||||
Address2: | SUITE 502 | ||||||||
City: | CAMDEN | ||||||||
State: | NJ | ||||||||
PostalCode: | 081031438 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8569636888 | ||||||||
FaxNumber: | 8569688499 | ||||||||
Practice Location | |||||||||
Address1: | 127 CHURCH RD | ||||||||
Address2: | SUITE 200 | ||||||||
City: | MARLTON | ||||||||
State: | NJ | ||||||||
PostalCode: | 080539402 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8569835691 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/24/2006 | ||||||||
LastUpdateDate: | 04/25/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MA68034 | NJ | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 2635585 | 01 | NJ | AETNA | OTHER | 2080979000 | 01 | NJ | AMERIHEALTH/KEYSTONE/IBC | OTHER | 2115525 | 01 | NJ | UNITED HEALTHCARE | OTHER | 2635585 | 01 | NJ | PA BS HIGHMARK | OTHER | 010003738 | 01 | NJ | AMERICHOICE | OTHER | 1391857 | 01 | NJ | AMERIHEALTH PPO/PA BS | OTHER | 3K6131 | 01 | NJ | HEALTHNET | OTHER | 7272169 | 01 | NJ | CIGNA | OTHER | P3196507 | 01 | NJ | OXFORD | OTHER | 30819 | 01 | NJ | UNIVERSITY HEALTH PLAN | OTHER | 3635169 | 01 | NJ | AETNA | OTHER |