Michael C Deal, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

029623 Issued in GA

Practice address

112 Hill Pond LN
Statesboro, GA 30458-0872

Phone

(912) 489-3325

Fax

(912) 489-7334

NPI assigned

Dec 29, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Dr. Michael C Deal Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• East Georgia Pediatrics

  • Specialist
  • Statesboro, GA
  • NPI 1295999795
  NPD (past) Authorized official
• East Georgia Nephrology, PC

  • Nephrology Physician
  • Statesboro, GA
  • NPI 1215128186
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473292800000",
    "number": "1669538815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 HILL POND LN",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580872",
            "telephone_number": "912-489-3325",
            "fax_number": "912-489-7334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 HILL POND LN",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580872",
            "telephone_number": "912-489-3325",
            "fax_number": "912-489-7334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEAL",
        "first_name": "MICHAEL",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2016-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "029623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "354428",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000372391G",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10051619",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "58-2643952",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHAEL",
            "last_name": "DEAL",
            "middle_name": "C",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Nicole Davis
• Emily Tripp Dawson, RN
• Aubrey R Dayton Kehoe
• Horace E Deal, OD
• Karen L Deal, FNP
• Wendy Deal
• Veronica B Debrah, RPH
• Brandon Michael Defeo, DPT
• Sreevalli Dega, MD
• Brian Mixon Deloach, M.D.

• Pediatrics Physician in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.