Basic Information
| Provider Information | |||||||||
| NPI: | 1740227818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISLEY | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5243 RIVERSIDE DR | ||||||||
| Address2: | APARTMENT 1802 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312108803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6785280241 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 REDMOND RD NW | ||||||||
| Address2: | ANESTHESIOLOGIST DEPARTMENT | ||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301651415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062910291 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 053761 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | P00217965 | 01 | GA | RAILROAD MEDICARE | OTHER |