Provider Demographics
NPI:1407858434
Name:YORK, MICHAEL JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JONATHAN
Last Name:YORK
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 1:2001 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 705
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1476
Mailing Address - Country:US
Mailing Address - Phone:404-355-0743
Mailing Address - Fax:404-355-2136
Practice Address - Street 1:1901 PHOENIX BLVD
Practice Address - Street 2:STE 200
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5588
Practice Address - Country:US
Practice Address - Phone:404-355-0743
Practice Address - Fax:770-991-6477
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032331207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000596109FMedicaid
0486290001OtherDME
RRBCB4505Medicare PIN
F51910Medicare UPIN
GA000596109FMedicaid