Provider Demographics
NPI:1841267606
Name:PINELL, MICHAEL C (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:PINELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 DUNGENESS
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-5461
Mailing Address - Country:US
Mailing Address - Phone:912-856-7618
Mailing Address - Fax:912-638-7755
Practice Address - Street 1:60 CINEMA LANE
Practice Address - Street 2:SUITE 250
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31523
Practice Address - Country:US
Practice Address - Phone:912-638-7799
Practice Address - Fax:912-638-7755
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58102207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA209719582AMedicaid
GA93BFCLCMedicare PIN
GA209719582AMedicaid