Provider Demographics
NPI:1992881122
Name:BLANEY, MICHAEL W (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:BLANEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904
Mailing Address - Country:US
Mailing Address - Phone:706-738-3359
Mailing Address - Fax:706-738-0565
Practice Address - Street 1:3830 WASHINGTON RD STE 17
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-5080
Practice Address - Country:US
Practice Address - Phone:706-922-0440
Practice Address - Fax:706-922-0441
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA40614208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG40614Medicaid
GA000906727CMedicaid
SCG40614Medicaid