Provider Demographics
NPI:1255094678
Name:BYRD, MICHAEL (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:BYRD
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 LAKESHORE CIR NE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-9055
Mailing Address - Country:US
Mailing Address - Phone:478-456-9092
Mailing Address - Fax:
Practice Address - Street 1:185 LAKESHORE CIR NE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-9055
Practice Address - Country:US
Practice Address - Phone:478-456-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN188620363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health