Provider Demographics
NPI:1013915586
Name:PICKFORD, MICHAEL JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:PICKFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3855 PLEASANT HILL RD STE 280
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8093
Mailing Address - Country:US
Mailing Address - Phone:678-312-7390
Mailing Address - Fax:678-312-7399
Practice Address - Street 1:3855 PLEASANT HILL RD
Practice Address - Street 2:SUITE 280
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1407
Practice Address - Country:US
Practice Address - Phone:678-312-7390
Practice Address - Fax:678-312-7399
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024063207YS0012X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2552774OtherAETNA
GA52280401OtherBCBS OF GEORGIA
GAO40016072OtherRAILROAD MEDICARE
GA2234680OtherCIGNA
GA5997OtherKAISER PERMANENTE
GA2234680OtherCIGNA
GA5997OtherKAISER PERMANENTE