Individual
DR. MICHAEL C DEAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
112 HILL POND LN, STATESBORO, GA 30458-0872
(912) 489-3325
(912) 489-7334
Mailing address
112 HILL POND LN, STATESBORO, GA 30458-0872
(912) 489-3325
(912) 489-7334
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
029623
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000372391G
—
GA
01
—
10051619
AMERIGROUP
GA
01
—
354428
WELLCARE
GA
01
—
58-2643952
TAX ID
—
Enumeration date
12/29/2006
Last updated
09/08/2016
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