Healthcare Provider Details

I. General information

NPI: 1437156189
Provider Name (Legal Business Name): MICHAEL K. MCFADDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 PERRY HWY STE 101
HAWKINSVILLE GA
31036-6748
US

IV. Provider business mailing address

3356 VINEVILLE AVE
MACON GA
31204-2328
US

V. Phone/Fax

Practice location:
  • Phone: 478-892-7246
  • Fax: 478-892-7247
Mailing address:
  • Phone: 478-476-9886
  • Fax: 478-476-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME166528
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number89324
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: