Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 065709 | GA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 65709 | GA |
NPI | 1033385679 |
---|---|
Provider Name | Keith Walter Michael |
First Address | Atlanta, GA 30329-2208 |
Second Address | Atlanta, GA 30329-2208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2008 |
Last Update Date | 30/03/2021 |