Provider Demographics
NPI:1164456240
Name:DYKES, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:DYKES
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 1:460 MALL BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4891
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:706-378-1204
Practice Address - Street 1:1601 FAIR RD STE 800
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0800
Practice Address - Country:US
Practice Address - Phone:800-827-6536
Practice Address - Fax:912-644-5260
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059148207L00000X
TN0000026586208VP0000X
GA05BDLQK208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA279204128Medicaid
TN3379916Medicaid
TNPN0102OtherJOHN DEERE HEALTH
G16560Medicare UPIN
TN4042440OtherBCBS