Provider Demographics
NPI:1144298399
Name:BABB, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:BABB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 MAXWELL RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2063
Mailing Address - Country:US
Mailing Address - Phone:770-274-0480
Mailing Address - Fax:770-740-0896
Practice Address - Street 1:318 MAXWELL RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2063
Practice Address - Country:US
Practice Address - Phone:770-274-0480
Practice Address - Fax:770-740-0896
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14271207Q00000X
TN47096208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100254140BMedicaid
OK731251724001OtherBCBS
OK100254140BMedicaid