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General NPI Number Information
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NPI Number | 1124043310
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Entity Type | Individual
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Provider Name | MICHAEL CHANNING BADGER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 6161 LAKE BRANDT RD UNIT B
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City | GREENSBORO
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State | NC
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Zip | 27455-8415
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Country | US
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Telephone | 336-643-5800
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Fax | 336-643-7474
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Provider Business Mailing Address
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Address Line | PO BOX 60447
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City | CHARLOTTE
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State | NC
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Zip | 28260-0447
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Country | US
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Telephone | 336-643-5800
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Fax | 336-643-7474
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 009901103
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License Number State | NC
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