Basic Information
| Provider Information | |||||||||
| NPI: | 1982839288 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNC CHAPEL HILL DOFM | ||||||||
| Address2: | 590 MANNING DRIVE, CB# 7595 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199661072 | ||||||||
| FaxNumber: | 9199666126 | ||||||||
| Practice Location | |||||||||
| Address1: | UNC CHAPEL HILL DOFM | ||||||||
| Address2: | 590 MANNING DRIVE, CB# 7595 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199661072 | ||||||||
| FaxNumber: | 9199666126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2009 | ||||||||
| LastUpdateDate: | 05/16/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 156703 | NC | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.