Individual
DR. MICHAEL K KIZZIAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
255 W 5TH ST SW, SUITE 150, ROME, GA 30165-2817
(706) 232-1545
(706) 232-3819
Mailing address
PO BOX 369, ROME, GA 30162-0369
(706) 291-2661
(706) 235-4177
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
27944
SC
2085R0202X
Diagnostic Radiology Physician
Primary
065694
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003123794B
—
GA
05
—
279442
—
SC
Enumeration date
10/16/2006
Last updated
11/09/2016
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