| Michael S Conley M.d., P.c. | |
|
315 W Ponce De Leon Ave Ste 360 Decatur GA 30030-2491 | |
| (404) 681-4100 | |
| (404) 681-2300 |
| Full Name | Michael S Conley M.d., P.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 315 W Ponce De Leon Ave Ste 360, Decatur, Georgia |
| Authorized Official Name and Position | Michael Sean Conley (CEO) |
| Authorized Official Contact | 4046814100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael S Conley M.d., P.c. 315 W Ponce De Leon Ave Ste 360 Decatur GA 30030-2491 Ph: (404) 681-4100 | Michael S Conley M.d., P.c. 315 W Ponce De Leon Ave Ste 360 Decatur GA 30030-2491 Ph: (404) 681-4100 |
| NPI Number | 1457535155 |
|---|---|
| Provider Enumeration Date | 12/18/2007 |
| Last Update Date | 06/29/2021 |
| Certification Date | 06/29/2021 |
| Medicare PECOS PAC ID | 2860489689 |
|---|---|
| Medicare Enrollment ID | O20040426001079 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457535155 | NPI | - | NPPES |
| 00752606A | Medicaid | GA | |
| GRP4459 | Other | GA | MEDICARE GROUP |
| 1457535155 | Other | GROUP NPI | |
| 1316010192 | Other | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 2084P0805X | Psychiatry & Neurology - Geriatric Psychiatry | 043583 (Georgia) | Secondary |
| Provider Name | Michael Sean Conley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316010192 PECOS PAC ID: 9436322393 Enrollment ID: I20111109000746 |
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