Healthcare Provider Details

I. General information

NPI: 1407389844
Provider Name (Legal Business Name): MICHAEL CASTILLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 JOHNSON FERRY RD STE 820
ATLANTA GA
30342-1608
US

IV. Provider business mailing address

980 JOHNSON FERRY RD STE 820
ATLANTA GA
30342-1608
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-9307
  • Fax: 404-252-5839
Mailing address:
  • Phone: 404-252-9307
  • Fax: 404-252-5839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number322391
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number103068
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: