Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 024063 | GA |
NPI | 1013915586 |
---|---|
Provider Name | Dr. Michael John Pickford |
First Address | Duluth, GA 30096-8093 |
Second Address | Duluth, GA 30096-1407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 16/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2234680 | CIGNA (01) | GA |
2552774 | AETNA (01) | GA |
52280401 | BCBS OF GEORGIA (01) | GA |
5997 | KAISER PERMANENTE (01) | GA |
D30466 | (02) | GA |
O40016072 | RAILROAD MEDICARE (01) | GA |