Healthcare Provider Details

I. General information

NPI: 1235625443
Provider Name (Legal Business Name): MICHEL GARCIA CRESPO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 08/13/2023
Certification Date: 08/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 HARPER ST
AUGUSTA GA
30912-0001
US

IV. Provider business mailing address

948 BRYAN CIR
GROVETOWN GA
30813-8207
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-5437
  • Fax:
Mailing address:
  • Phone: 305-815-4173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14790-I
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number91345
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: