Provider Demographics
NPI:1386602662
Name:RENNER, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:RENNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 N POINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:127 OLD HIGHWAY 96 STE B
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-3461
Practice Address - Country:US
Practice Address - Phone:478-352-7143
Practice Address - Fax:478-352-7144
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA080178726Medicaid
GAGRP4178OtherMEDICARE GROUP NUMBER
GA080178726OtherRAIL ROAD MEDICARE NUMBER
GA08BDVTX GRP4178Medicare PIN
GA08BDVTXMedicare ID - Type Unspecified
GA080178726OtherRAIL ROAD MEDICARE NUMBER