Provider Demographics
NPI:1952393845
Name:LITTLE, MICHAEL JACKSON (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JACKSON
Last Name:LITTLE
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 1:321 BURDEN TER
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5710
Mailing Address - Country:US
Mailing Address - Phone:530-872-1035
Mailing Address - Fax:360-678-1346
Practice Address - Street 1:5974 PENTZ RD
Practice Address - Street 2:FEATHER RIVER HOSPITAL - CANYON VIEW CLINIC
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5509
Practice Address - Country:US
Practice Address - Phone:530-872-2000
Practice Address - Fax:530-876-2164
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000381132084P0800X
CAG340222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry