Healthcare Provider Details

I. General information

NPI: 1386602662
Provider Name (Legal Business Name): MICHAEL J RENNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 OLD HIGHWAY 96 STE B
BONAIRE GA
31005-3461
US

IV. Provider business mailing address

4300 N POINT PKWY STE 300
ALPHARETTA GA
30022-4102
US

V. Phone/Fax

Practice location:
  • Phone: 478-352-7143
  • Fax: 478-352-7144
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number038594
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: