Healthcare Provider Details

I. General information

NPI: 1215180526
Provider Name (Legal Business Name): MICHAEL WILLIAM GROVES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1499 WALTON WAY
AUGUSTA GA
30901-2602
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-4435
  • Fax: 706-721-0112
Mailing address:
  • Phone: 706-724-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number65664
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: