Provider Demographics
NPI:1356362826
Name:MUNSEY, MICHAEL ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:MUNSEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:115 LEE BYRD ROAD
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-2310
Mailing Address - Country:US
Mailing Address - Phone:770-554-4717
Mailing Address - Fax:770-554-4681
Practice Address - Street 1:115 LEE BYRD RD
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2310
Practice Address - Country:US
Practice Address - Phone:770-554-4717
Practice Address - Fax:770-554-4681
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA054811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00242428OtherMEDICARE RAILROAD
GA541786107AMedicaid
GA08BBRBZMedicare PIN