Provider Demographics
NPI:1437156189
Name:MCFADDEN, MICHAEL K (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:MCFADDEN
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 1:3356 VINEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2328
Mailing Address - Country:US
Mailing Address - Phone:478-476-9886
Mailing Address - Fax:478-476-9976
Practice Address - Street 1:202 PERRY HWY STE 101
Practice Address - Street 2:
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-6748
Practice Address - Country:US
Practice Address - Phone:478-892-7246
Practice Address - Fax:478-892-7247
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME166528208VP0014X
GA89324208VP0014X
IN01053559A208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
458214OtherHEALTHLINK
IN200318550AMedicaid
000000185016OtherANTHEM
G99757Medicare UPIN
000000185016OtherANTHEM