MEDICARE: DR. MICAH R FISHER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	056546	GA

General Provider Information

NPI Number	:	1477545499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICAH R FISHER MD

Provider Business Mailing Address
First Line	:	1365A CLIFTON RD NE
Second Line	:	4TH FLOOR
City	:	ATLANTA
State	:	GA
Zip	:	30322-1013
Country	:	US
Telephone Number	:	404-778-5734
Fax Number	:	404-778-4431

Provider Business Practice Location Address
First Line	:	1365A CLIFTON RD NE
Second Line	:	4TH FLOOR
City	:	ATLANTA
State	:	GA
Zip	:	30322-1013
Country	:	US
Telephone Number	:	404-778-5734
Fax Number	:	404-778-4431

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/08/2007

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