Provider Demographics
NPI:1508800475
Name:CLIFFORD, MICHAEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:CLIFFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:208 N CUTHBERT ST
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-3517
Mailing Address - Country:US
Mailing Address - Phone:229-758-3344
Mailing Address - Fax:229-758-6622
Practice Address - Street 1:208 N CUTHBERT ST
Practice Address - Street 2:MILLER COUNTY MEDICAL CENTER
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837-3517
Practice Address - Country:US
Practice Address - Phone:229-758-3344
Practice Address - Fax:229-758-6622
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037508208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000579543CMedicaid
GA01BDGRFMedicare PIN
GAP00172478Medicare PIN
D78929Medicare UPIN