Provider Demographics
NPI:1851968184
Name:ANTHONY, MICHAEL DANIEL (RN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DANIEL
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 RAVENWOOD CT APT A
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-0141
Mailing Address - Country:US
Mailing Address - Phone:229-894-6735
Mailing Address - Fax:
Practice Address - Street 1:121 RAVENWOOD CT APT A
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-0141
Practice Address - Country:US
Practice Address - Phone:229-894-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN259485163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine