Provider Demographics
NPI:1356381917
Name:MICHAELS, JOHN F JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:MICHAELS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:F
Other - Last Name:MICHAELS
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1707 BOULEVARD SQ
Mailing Address - Street 2:SUITE A
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-8029
Mailing Address - Country:US
Mailing Address - Phone:912-490-0078
Mailing Address - Fax:912-490-0048
Practice Address - Street 1:1707 BOULEVARD SQ
Practice Address - Street 2:SUITE A
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-8029
Practice Address - Country:US
Practice Address - Phone:912-490-0078
Practice Address - Fax:912-490-0048
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0293502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000383435FMedicaid
GA000383435CMedicaid
GA000383435NMedicaid
GA000383435EMedicaid
GA000383435HMedicaid
GA52271563-006OtherBCBS-TIFTON
GA52271563-004OtherBCBS-VALDOSTA
GA000383435DMedicaid
GA52271563-003OtherBCBS-DOUGLAS