Provider Demographics
NPI:1871777300
Name:WORTHY, MICHAEL R (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:WORTHY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 572
Mailing Address - Street 2:19 S. MAIN ST.
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546
Mailing Address - Country:US
Mailing Address - Phone:706-896-4154
Mailing Address - Fax:706-896-4156
Practice Address - Street 1:19 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546
Practice Address - Country:US
Practice Address - Phone:706-896-4154
Practice Address - Fax:706-896-4156
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA09214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist