Individual
DR. MICHAEL ANTHONY AVIDANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1101 HOSPITAL DR, STE 100A, STOCKBRIDGE, GA 30281-9076
(770) 474-7416
(770) 389-6210
Mailing address
1101 HOSPITAL DR, SUITE 100A, STOCKBRIDGE, GA 30281-9075
(770) 474-7416
(770) 389-6210
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
039722
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000674726
—
GA
Enumeration date
06/27/2005
Last updated
01/04/2010
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