Provider Demographics
NPI:1184624876
Name:BELCON, MICHAEL CARVER (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CARVER
Last Name:BELCON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:C
Other - Last Name:BELCON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1499 WALTON WAY STE 1400
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2603
Mailing Address - Country:US
Mailing Address - Phone:706-721-1450
Mailing Address - Fax:706-721-1402
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-1450
Practice Address - Fax:706-721-1402
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 70220207K00000X, 207R00000X, 207RR0500X
GA075391207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70220OtherME
FL300947500Medicaid
FL28996OtherBX
FL300947500Medicaid
FL70220OtherME