=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659487874
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL JAMES STRELECKIS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3931 MUNDY MILL RD VA OAKWOOD CLINIC
-----------------------------------------------------
City | OAKWOOD
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30566-3413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-321-6111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5943 WILD RIVER VW
-----------------------------------------------------
City | SUGAR HILL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30518-8188
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-614-9568
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 041490
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------