Provider Demographics
NPI:1629257787
Name:TAORMINA, MICHAEL ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:TAORMINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2786
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-2786
Mailing Address - Country:US
Mailing Address - Phone:912-871-8900
Mailing Address - Fax:912-871-8901
Practice Address - Street 1:1601 FAIR RD
Practice Address - Street 2:SUITE 400
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-1698
Practice Address - Country:US
Practice Address - Phone:912-871-8900
Practice Address - Fax:912-871-8901
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0402582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10062139OtherAMERIGROUP
GA342043OtherWELLCARE
GA52676473001OtherBCBS
F73340Medicare UPIN
GA52676473001OtherBCBS