Healthcare Provider Details

I. General information

NPI: 1871622548
Provider Name (Legal Business Name): MICHAEL A REGISTER DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 01/13/2021
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3689 WILMA EDWARDS RD
ELLABELL GA
31308-5315
US

IV. Provider business mailing address

PO BOX 1047
ELLABELL GA
31308-1047
US

V. Phone/Fax

Practice location:
  • Phone: 912-653-4357
  • Fax: 912-653-4320
Mailing address:
  • Phone: 912-653-4357
  • Fax: 912-653-4320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number026924
License Number StateGA

VIII. Authorized Official

Name: DR. MICHAEL ANDREW REGISTER
Title or Position: OWNER
Credential: DO
Phone: 912-653-4357