Healthcare Provider Details

I. General information

NPI: 1013915586
Provider Name (Legal Business Name): MICHAEL JOHN PICKFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 PLEASANT HILL RD SUITE 280
DULUTH GA
30096-1407
US

IV. Provider business mailing address

3855 PLEASANT HILL RD STE 280
DULUTH GA
30096-8093
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-7390
  • Fax: 678-312-7399
Mailing address:
  • Phone: 678-312-7390
  • Fax: 678-312-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number024063
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number024063
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: