Healthcare Provider Details

I. General information

NPI: 1821892985
Provider Name (Legal Business Name): DR. MICHAEL ANTHONY MONTANO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HEMLOCK ST
MACON GA
31201-2102
US

IV. Provider business mailing address

1014 FORSYTH ST STE 100
MACON GA
31201-2051
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-4350
  • Fax:
Mailing address:
  • Phone: 478-633-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17167
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: