DR. MICHAEL L KLYACHKIN (NPI# 1811976053) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811976053 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL L KLYACHKIN |
| Credential | M.D. |
| Practice Address |
688 Walnut St Ste 200 Macon GA 31201-2677 |
| Practice Telephone | 4787427566 |
| Practice Fax Number | 4787432804 |
| Mailing Telephone | 4787427566 |
| Mailing Fax Number | 4787432804 |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2008-08-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
54760 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 519931565A | 05 | |
| MEDICARE | 511I770014 | 01 |
| Street Address |
688 WALNUT ST STE 200 |
| City | MACON |
| State | GA |
| Zip Code | 31201-2677 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861471096 | Fady S Wanna | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 688 Walnut St, Suite 102, Macon, GA 31201 | 2006-01-16 |
| 1902337637 | Premier Cardiothoracic Surgery, LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 688 Walnut St, Suite 102, Macon, GA 31201-2677 | 2017-03-24 |
| 1720430630 | Vascular Lab of Central Georgia LLC | Clinic/Center | 688 Walnut St, 201, Macon, GA 31201-2677 | 2016-07-05 |
| 1710399217 | Melanie Wheeler | Nurse Practitioner | 688 Walnut St, Suite 200, Macon, GA 31201-2677 | 2014-06-02 |
| 1811276116 | Nancy Katherine Mclaurin | Nurse Practitioner | 688 Walnut St, Ste 200, Macon, GA 31201-2677 | 2011-08-04 |
| 1316181159 | Next Level Community Development Center, Inc. | Counselor | 688 Walnut St, 202, Macon, GA 31201-2677 | 2009-04-23 |
| 1003050840 | Carolyn Woodard | Counselor | 688 Walnut St, 202, Macon, GA 31201-2677 | 2009-04-23 |
| 1730365727 | Vascular Access Center of Georgia LLC | Radiology | 688 Walnut St, Suite 201, Macon, GA 31201-2677 | 2008-01-21 |
| 1366516338 | Cardio Thoracic Vascular & Pediatric Surgery Assoc PC | Surgery | 688 Walnut St, Suite 200, Macon, GA 31201-2677 | 2006-11-20 |
| 1578647277 | Tracy Denise Davis | Physician Assistant | 688 Walnut St, Suite 200, Macon, GA 31201-2677 | 2006-10-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639666340 | Yasameen Emad Muzahim | Internal Medicine | 777 Hemlock Street, Msc 165, Macon, GA 31201 | 2018-04-18 |
| 1952819419 | Putnam Dialysis LLC | Clinic/Center | 657 Hemlock Street, Suite 200, Macon, GA 31201 | 2018-01-18 |
| 1730604331 | Graham Arthur Mercier | Surgery | 169 Ashley Ave., Room 202 Main Hospital Msc 333, Charleston, SC 31201 | 2017-08-04 |
| 1376075705 | Diamond Jude | Internal Medicine | 777 Hemlock Street Msc #104, Macon, GA 31201 | 2017-04-03 |
| 1174055263 | Carol Roobin Bashuk | Hearing Instrument Specialist | 634 First Street, Macon, GA 31201 | 2017-03-29 |
| 1144752411 | Hubert Pare | Student in an Organized Health Care Education/Training Program | 777 Hemlock Street, Msc# 165, Macon, GA 31201 | 2017-03-28 |
| 1548613789 | Michael Daugherty | Counselor | 1873 Hardeman Ave, Suite 1, Macon, GA 31201 | 2016-07-22 |
| 1316317993 | 4front Healthcare of Middle Georgia, LLC | Hospice Care, Community Based | 682 1st St, Macon, GA 31201 | 2015-09-25 |
| 1881073054 | Andrew Lee Drahos | Surgery | 777 Hemlock St # 140, Macon, GA 31201 | 2015-05-21 |
| 1720474158 | April Nicole Colley | Nurse Practitioner | 1014 Forsyth Street, Macon, GA 31201 | 2015-04-13 |
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| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528218393 | Vladimir Zahradnik | Surgery | 380 Hospital Dr Bldg A Ste 320, Macon, GA 31217 | 2008-09-29 |
| 1417381781 | Macon Vascular Care, LLC | Surgery | 889 2nd St, Macon, GA 31201-6862 | 2013-08-22 |
| 1659525178 | Bruce Jeremy Innes | Surgery | 777 Hemlock St, Msc 99, Macon, GA 31201-2102 | 2008-11-11 |
| 1558543389 | John William Mix | Surgery | 575 1st St, Macon, GA 31201-2825 | 2007-12-04 |
| 1366516338 | Cardio Thoracic Vascular & Pediatric Surgery Assoc PC | Surgery | 688 Walnut St, Suite 200, Macon, GA 31201-2677 | 2006-11-20 |
| 1619956851 | William B Schroder | Surgery | 575 1st St, Macon, GA 31201-2825 | 2006-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285241265 | Jennifer Ann Hales | Surgery | 11090 Mcauley, Suite 100 2a, Savannah, GA 31419 | 2020-09-24 |
| 1902423387 | Center for Vein Restoration Ga Corp | Surgery | 1100 Johnson Fy Rd Ne Ste 165, Atlanta, GA 30342-1795 | 2020-07-01 |
| 1487133278 | Usa Vascular Center of Decatur LLC | Surgery | 495 Winn Way Ste 230, Decatur, GA 30030-1736 | 2018-08-13 |
| 1841789914 | Milner Vein and Vascular LLC | Surgery | 5700 Hillandale Dr Ste 150, Lithonia, GA 30058 | 2018-05-04 |
| 1023517505 | Antioch Vascular Center, LLC | Surgery | 9104 Middleground Road, Suite 2, Savannah, GA 31406 | 2018-02-09 |
| 1689012205 | Daniel Joseph Badia | Surgery | 601 Professional Dr Ste A220, Lawrenceville, GA 30046-7698 | 2013-06-05 |
| 1740507425 | Christopher Ray Ramos | Surgery | 1365 Clifton Road Ne, Building A, Room A2200, Atlanta, GA 30322 | 2010-04-21 |
| 1184879678 | Rockdale Vascular and Thoracic Surgery, LLC | Surgery | 1368c Wellbrook Cir Ne, Conyers, GA 30012-3872 | 2008-11-25 |
| 1487819132 | Yazan Duwayri | Surgery | Division of Vascular Surgery Emory Clinic Bldg A, 1365 Clifton Road Ne. 3rd Floor, Atlanta, GA 30322-0001 | 2008-07-22 |
| 1033372610 | Robert S Crawford | Surgery | 5673 Peachtree Dunwoody Ste 675, Atlanta, GA 30342-1774 | 2008-07-03 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.