Provider Demographics
NPI:1174675748
Name:REGISTER, MICHAEL ANDREW (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:REGISTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1047
Mailing Address - Street 2:
Mailing Address - City:ELLABELL
Mailing Address - State:GA
Mailing Address - Zip Code:31308-1047
Mailing Address - Country:US
Mailing Address - Phone:912-653-4357
Mailing Address - Fax:912-653-4320
Practice Address - Street 1:3689 WILMA EDWARDS RD
Practice Address - Street 2:
Practice Address - City:ELLABELL
Practice Address - State:GA
Practice Address - Zip Code:31308-5315
Practice Address - Country:US
Practice Address - Phone:912-653-4357
Practice Address - Fax:912-653-4320
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA026924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA288582981AMedicaid
GA08BBQTFMedicare ID - Type Unspecified
GAD30588Medicare UPIN