Individual
DR. MICHAEL GEORGE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
391 EAST MAIN STREET, HISTORIC HAWKINS BUILDING, CANTON, GA 30114-2712
(770) 720-6963
(770) 720-6965
Mailing address
391 EAST MAIN STREET, HISTORIC HAWKINS BUILDING, CANTON, GA 30114-2712
(770) 720-6963
(770) 720-6965
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
054532
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1609087972
AUTHORIZED CONTACT REPRESENTATIVE: STEPHANIE H. ANDERSON, NPI#
GA
05
—
268736326A
—
GA
01
—
629697125A
MEDICAID PAYOR ID# EMPLOYER NORTHSIDE CHILDREN'S PEDIATRICS CTR, NPI# 1396945515
GA
Enumeration date
11/14/2006
Last updated
10/01/2012
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