Provider Demographics
NPI:1588795934
Name:STECHISON, MICHAEL THOMAS (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:STECHISON
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 116156
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6156
Mailing Address - Country:US
Mailing Address - Phone:678-312-5525
Mailing Address - Fax:770-339-2120
Practice Address - Street 1:575 PROFESSIONAL DRIVE
Practice Address - Street 2:SUITE 350
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3347
Practice Address - Country:US
Practice Address - Phone:678-312-2700
Practice Address - Fax:678-312-2730
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA040561207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00669534AMedicaid
GAE9722Medicare UPIN
GA00669534AMedicaid