Individual
MR. MICHAEL P KAVANAGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
6600 VAN AALST BLVD, FORT MOORE, GA 31905-2102
(762) 408-1467
Mailing address
125 PERRYS MILL RD, PINE MOUNTAIN, GA 31822-5112
(706) 663-9715
(770) 683-4872
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
34
GA
224P00000X
Prosthetist
34
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
836804665A
—
GA
Enumeration date
12/22/2006
Last updated
02/04/2025
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