Healthcare Provider Details

I. General information

NPI: 1245767383
Provider Name (Legal Business Name): MICHAEL JOHN SYLVESTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 08/19/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 HIGHWAY 54 W STE 710
FAYETTEVILLE GA
30214-4565
US

IV. Provider business mailing address

1240 HIGHWAY 54 W STE 710
FAYETTEVILLE GA
30214-4565
US

V. Phone/Fax

Practice location:
  • Phone: 770-991-2800
  • Fax:
Mailing address:
  • Phone: 770-991-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301502978
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301112579
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number95856
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: