Provider Demographics
NPI:1154305191
Name:LEVINE, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1620
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2209
Mailing Address - Country:US
Mailing Address - Phone:404-885-7701
Mailing Address - Fax:404-885-7777
Practice Address - Street 1:2520 WINDY HILL RD SE
Practice Address - Street 2:SUITE 102
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8664
Practice Address - Country:US
Practice Address - Phone:770-612-8165
Practice Address - Fax:770-612-8195
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2011-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA12932207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000011261EMedicaid
10BDHHGMedicare ID - Type Unspecified
GA000011261EMedicaid