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General NPI Number Information
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NPI Number | 1871820852
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Entity Type | Individual
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Provider Name | MATTHEW CARMICHAEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/11/2009
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 766 WALTHER RD STE 300
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046
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Country | US
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Telephone | 770-237-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 766 WALTHER RD STE 300
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8765
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Country | US
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Telephone | 770-237-3000
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Fax |
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 79617
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License Number State | GA
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