Provider Demographics
NPI:1922299957
Name:HOLCOMBE, MICHAEL PAUL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
Last Name:HOLCOMBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:HOLCOMBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0369
Mailing Address - Country:US
Mailing Address - Phone:706-291-2661
Mailing Address - Fax:706-235-4177
Practice Address - Street 1:901 N BROAD ST NE
Practice Address - Street 2:SUITE 220
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-5207
Practice Address - Country:US
Practice Address - Phone:706-291-2661
Practice Address - Fax:706-235-4177
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070124332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003123794BMedicaid
GA003123794BMedicaid