Provider Demographics
NPI:1114213428
Name:MONAHAN, MICHAEL BLAIR (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BLAIR
Last Name:MONAHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2400 OSLER CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-0205
Mailing Address - Country:US
Mailing Address - Phone:229-449-1676
Mailing Address - Fax:229-432-7583
Practice Address - Street 1:2400 OSLER CT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707
Practice Address - Country:US
Practice Address - Phone:229-449-1676
Practice Address - Fax:229-432-7583
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019165208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology