Healthcare Provider Details

I. General information

NPI: 1013570415
Provider Name (Legal Business Name): MICHAEL CHARLES HORWATH MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2019
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON ROAD NE RM H-184
ATLANTA GA
30332
US

IV. Provider business mailing address

1364 CLIFTON ROAD NE RM H-184
ATLANTA GA
30332-5345
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-8657
  • Fax:
Mailing address:
  • Phone: 404-727-8657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number01093207A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number01093207A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: