Provider Demographics
NPI:1649228792
Name:HELLWEGE, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:HELLWEGE
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 1:1701 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3633
Mailing Address - Country:US
Mailing Address - Phone:478-923-0144
Mailing Address - Fax:478-953-5340
Practice Address - Street 1:1701 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3633
Practice Address - Country:US
Practice Address - Phone:478-923-0144
Practice Address - Fax:478-923-3471
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030090208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00426742AMedicaid
GA020010080OtherRAILROAD MEDICARE
GA02BDBJPMedicare PIN
GA00426742AMedicaid