Provider Demographics
NPI:1508892431
Name:FISHMAN, MICHAEL LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEE
Last Name:FISHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5448 YORKTOWNE DR
Mailing Address - Street 2:SUITE 127
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5317
Mailing Address - Country:US
Mailing Address - Phone:678-251-3184
Mailing Address - Fax:770-997-7534
Practice Address - Street 1:5448 YORKTOWNE DR
Practice Address - Street 2:SUITE 127
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5317
Practice Address - Country:US
Practice Address - Phone:678-251-3184
Practice Address - Fax:770-997-7534
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA030061101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01BDFBTMedicare ID - Type UnspecifiedNOT ACTIVE
GAE98894Medicare UPIN