Provider Demographics
NPI:1174606941
Name:HOWELL, MICHAEL GEORGE (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:HOWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 WHEELER DR
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-8900
Mailing Address - Country:US
Mailing Address - Phone:662-862-2025
Mailing Address - Fax:662-862-2026
Practice Address - Street 1:204 WHEELER DR
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-8900
Practice Address - Country:US
Practice Address - Phone:662-862-2025
Practice Address - Fax:662-862-2026
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00019915Medicaid
MSD00929Medicare UPIN
MS080001205Medicare ID - Type Unspecified