Basic Information
| Provider Information | |||||||||
| NPI: | 1073512802 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIEGNER | ||||||||
| FirstName: | MICAH | ||||||||
| MiddleName: | DELLANY HIERS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RIEGNER | ||||||||
| OtherFirstName: | MICAH | ||||||||
| OtherMiddleName: | DELLANY | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 310 EISENHOWER DR | ||||||||
| Address2: | BLDG. 16 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314062632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123033500 | ||||||||
| FaxNumber: | 9123033509 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 EISENHOWER DR | ||||||||
| Address2: | BLDG. 16 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314062632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123033500 | ||||||||
| FaxNumber: | 9123033509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 047991 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 866041 | 01 | GA | BCBS | OTHER | G47991 | 05 | SC | MEDICAID |