Provider Demographics
NPI:1669538815
Name:DEAL, MICHAEL C (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:DEAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:C
Other - Last Name:DEAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:112 HILL POND LN
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0872
Mailing Address - Country:US
Mailing Address - Phone:912-489-3325
Mailing Address - Fax:912-489-7334
Practice Address - Street 1:112 HILL POND LN
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0872
Practice Address - Country:US
Practice Address - Phone:912-489-3325
Practice Address - Fax:912-489-7334
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029623208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA354428OtherWELLCARE
GA000372391GMedicaid
GA10051619OtherAMERIGROUP
58-2643952OtherTAX ID