Provider Demographics
NPI:1912089533
Name:PARE, MICHEL CAMILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:CAMILLE
Last Name:PARE
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 1587
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-1587
Mailing Address - Country:US
Mailing Address - Phone:706-529-7437
Mailing Address - Fax:706-529-7437
Practice Address - Street 1:2622 MEREDYTH DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707
Practice Address - Country:US
Practice Address - Phone:229-312-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045569174400000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP01075686OtherRR MEDICARE
GA676904OtherWELLCARE
GA000793482EMedicaid
GA01650081OtherAMERIGROUP
GAP01075686OtherRR MEDICARE
GA4313010001Medicare NSC
GA202I145602Medicare PIN