Provider Demographics
NPI:1508609777
Name:FLEMING, MICHAEL TIMOTHY (LCPO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TIMOTHY
Last Name:FLEMING
Suffix:
Gender:M
Credentials:LCPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 ROBERTSON AVE
Mailing Address - Street 2:
Mailing Address - City:THUNDERBOLT
Mailing Address - State:GA
Mailing Address - Zip Code:31404-5330
Mailing Address - Country:US
Mailing Address - Phone:912-224-8763
Mailing Address - Fax:
Practice Address - Street 1:110 PIPEMAKERS CIR STE 115
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4168
Practice Address - Country:US
Practice Address - Phone:912-988-1526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACPO03353222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist