Provider Demographics
NPI:1396766143
Name:PRESTON, MICHAEL C (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:PRESTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-1109
Mailing Address - Country:US
Mailing Address - Phone:706-935-9024
Mailing Address - Fax:706-935-3448
Practice Address - Street 1:1542 POPLAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-3333
Practice Address - Country:US
Practice Address - Phone:706-935-9024
Practice Address - Fax:706-935-3448
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047644207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000839517BMedicaid
GA000839517EMedicaid
GAP00282931OtherRAILROAD MEDICARE
TN3144649OtherBCBS OF TENNESSEE
TN3827734Medicaid
GAP00282931OtherRAILROAD MEDICARE
GA93BBKHSMedicare PIN
GAD56769Medicare UPIN