Provider Demographics
NPI:1669423554
Name:CONNOLLY, MICHAEL G JR (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:CONNOLLY
Suffix:JR
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 1:1022 1ST STREET NORTH
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007
Mailing Address - Country:US
Mailing Address - Phone:205-664-5935
Mailing Address - Fax:205-664-5233
Practice Address - Street 1:2030 LAY DAM RD
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-8344
Practice Address - Country:US
Practice Address - Phone:205-258-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16393207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000027899Medicaid
AL000027902Medicaid
AL000027901Medicaid
AL000027902Medicare PIN
AL000027902Medicaid
AL000027901Medicaid