Basic Information
| Provider Information | |||||||||
| NPI: | 1821077793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 775 POPLAR RD | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302658300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702530611 | ||||||||
| FaxNumber: | 7705020521 | ||||||||
| Practice Location | |||||||||
| Address1: | 775 POPLAR RD | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | NEWNAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302658300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702530611 | ||||||||
| FaxNumber: | 7705020521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 11/05/2015 | ||||||||
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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 | 207RC0000X | 46177 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207UN0901X | 046177 | GA | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology |
No ID Information.