Provider Demographics
NPI:1073512802
Name:RIEGNER, MICAH DELLANY HIERS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:DELLANY HIERS
Last Name:RIEGNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MICAH
Other - Middle Name:DELLANY
Other - Last Name:RIEGNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:310 EISENHOWER DR
Mailing Address - Street 2:BLDG. 16
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2632
Mailing Address - Country:US
Mailing Address - Phone:912-303-3500
Mailing Address - Fax:912-303-3509
Practice Address - Street 1:310 EISENHOWER DR
Practice Address - Street 2:BLDG. 16
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2632
Practice Address - Country:US
Practice Address - Phone:912-303-3500
Practice Address - Fax:912-303-3509
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047991208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA866041OtherBCBS
SCG47991Medicaid
GA37BBGPZMedicare ID - Type Unspecified
GA866041OtherBCBS