Provider Demographics
NPI:1043427834
Name:MITCHELL, MICHAEL BYRON (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BYRON
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-358-9630
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:128 HIGHLAND PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-5577
Practice Address - Country:US
Practice Address - Phone:601-358-9630
Practice Address - Fax:601-579-5240
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL268722084N0400X
MS201782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06902001Medicaid
MS9277184OtherAETNA
LA1365173Medicaid
MS9277184OtherAETNA
MS9277184OtherAETNA