Provider Demographics
NPI:1851529424
Name:PEREIRA, MIGUEL ALEXIS (MD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ALEXIS
Last Name:PEREIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MIGUEL
Other - Middle Name:ALEXIS
Other - Last Name:PEREIRA RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1125 TROUPE ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4480
Mailing Address - Country:US
Mailing Address - Phone:706-737-4575
Mailing Address - Fax:
Practice Address - Street 1:4350 TOWNE CENTRE DR STE 1000
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3328
Practice Address - Country:US
Practice Address - Phone:706-737-4575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY472882085R0202X
GA1021332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology