Provider Demographics
NPI:1821048042
Name:CECIL, MICHAEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:CECIL
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 1:4140 TATE ST NE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2562
Mailing Address - Country:US
Mailing Address - Phone:770-786-0077
Mailing Address - Fax:770-786-8750
Practice Address - Street 1:4140 TATE ST NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2562
Practice Address - Country:US
Practice Address - Phone:770-786-0077
Practice Address - Fax:770-786-8750
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30031207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00623191DMedicaid
GA00623191EMedicaid
GAF55131Medicare UPIN
GA00623191DMedicaid