MEDICARE: MR. MICHAEL EUGENE SECKINGER SR. CN

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	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1922270321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL EUGENE SECKINGER SR. CN

Provider Business Mailing Address
First Line	:	4923 ARMOUR RD
Second Line	:	SUITE 200
City	:	COLUMBUS
State	:	GA
Zip	:	31904
Country	:	US
Telephone Number	:	706-322-1803
Fax Number	:	706-322-1804

Provider Business Practice Location Address
First Line	:	4923 ARMOUR RD
Second Line	:	SUITE 200
City	:	COLUMBUS
State	:	GA
Zip	:	31904
Country	:	US
Telephone Number	:	706-322-1803
Fax Number	:	706-322-1804

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

Provider Enumeration Date	:	03/26/2008
Last Update Date	:	03/26/2008

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