Provider Demographics
NPI:1083652879
Name:MCDONOUGH, MICHEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:M
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1430 HARPER ST
Mailing Address - Street 2:BLDG A
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-0617
Mailing Address - Country:US
Mailing Address - Phone:706-724-2261
Mailing Address - Fax:706-724-2523
Practice Address - Street 1:1430 HARPER ST
Practice Address - Street 2:BLDG A
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-0617
Practice Address - Country:US
Practice Address - Phone:706-724-2261
Practice Address - Fax:706-724-2523
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA036820207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000655817AMedicaid
GA16BDDZMMedicare ID - Type Unspecified
GA000655817AMedicaid