MEDICARE: MIGUEL CARMONA PIRES 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	207R00000X	Internal Medicine Physician	82843	GA

General Provider Information

NPI Number	:	1720514540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUEL CARMONA PIRES MD

Provider Business Mailing Address
First Line	:	1014 W FRANKLIN ST
Second Line	:
City	:	SYLVESTER
State	:	GA
Zip	:	31791-1978
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9202 HIGHWAY 278 NE
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-7011
Country	:	US
Telephone Number	:	678-342-8660
Fax Number	:

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	08/15/2023

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