Provider Demographics
NPI:1487702072
Name:COURTNEY, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:COURTNEY
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 1:80 HERREN HILL RD STE F
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-1264
Mailing Address - Country:US
Mailing Address - Phone:334-283-3896
Mailing Address - Fax:334-283-3837
Practice Address - Street 1:80 HERREN HILL RD STE F
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-1264
Practice Address - Country:US
Practice Address - Phone:334-283-3896
Practice Address - Fax:334-283-3837
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13184208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051553052Medicaid
J249OtherMEDICARE GP PAYOR ID
AL51513099COUOtherBCBS PROVIDER NUMBER
J249OtherMEDICARE GP PAYOR ID
AL051553052COUMedicare ID - Type UnspecifiedPROVIDER NUMBER