Healthcare Provider Details

I. General information

NPI: 1487217519
Provider Name (Legal Business Name): MICHAEL JOHN ANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6055 LAKESIDE COMMONS DR STE 320
MACON GA
31210-5791
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 478-238-9344
  • Fax: 478-225-0566
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10817
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: