Provider Demographics
NPI:1164524534
Name:FISHER, MICHAEL ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:138 MOCKINGBIRD HILL LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-7174
Mailing Address - Country:US
Mailing Address - Phone:865-483-3434
Mailing Address - Fax:865-483-9390
Practice Address - Street 1:665B EMORY VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7762
Practice Address - Country:US
Practice Address - Phone:865-483-3434
Practice Address - Fax:865-483-9390
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000138272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3023534Medicaid
TNA98745Medicare UPIN
TN3023534Medicaid