Healthcare Provider Details

I. General information

NPI: 1104822196
Provider Name (Legal Business Name): MICHAEL LAWRENCE FISHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 HICKORY BLVD
GRANITE FALLS NC
28645-1992
US

IV. Provider business mailing address

4355 HICKORY BLVD
GRANITE FALLS NC
28645-1992
US

V. Phone/Fax

Practice location:
  • Phone: 828-757-5060
  • Fax: 828-757-5064
Mailing address:
  • Phone: 828-757-5060
  • Fax: 828-757-5064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9800047
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: