Provider Demographics
NPI:1891738183
Name:FISCHER, PAUL M (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:FISCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2510
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809
Mailing Address - Country:US
Mailing Address - Phone:706-650-7799
Mailing Address - Fax:706-650-9540
Practice Address - Street 1:4039 GATEWAY BLVD
Practice Address - Street 2:GATEWAY BLVD
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-3195
Practice Address - Country:US
Practice Address - Phone:706-922-1600
Practice Address - Fax:706-922-1010
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA336962OtherWELLCARE
GACH0654OtherRR MEDICARE GROUP PIN
SCG25973Medicaid
GA00278297BMedicaid
GA10057146OtherAMERIGROUP
GA10057146OtherAMERIGROUP
GA00278297BMedicaid