Provider Demographics
NPI:1992917991
Name:OTT, MICKEY MEILINGER (M D)
Entity type:Individual
Prefix:DR
First Name:MICKEY
Middle Name:MEILINGER
Last Name:OTT
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6278
Mailing Address - Country:US
Mailing Address - Phone:912-350-7412
Mailing Address - Fax:912-350-7297
Practice Address - Street 1:4750 WATERS AVE STE 202
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6278
Practice Address - Country:US
Practice Address - Phone:912-350-7412
Practice Address - Fax:912-350-7297
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA070227208600000X, 2086S0102X
TNMD45032208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGA1461Medicaid
GA003135033AMedicaid
GAP01198992OtherRAILROAD MEDICARE
GAP01198992OtherRAILROAD MEDICARE