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NPI Code Detail

MEDICARE: MR. MICHAEL VICTOR SHIBLEY PA

MEDICARE: MR. MICHAEL VICTOR SHIBLEY PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant006164GA

General Provider Information

NPI Number : 1750678843
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL VICTOR SHIBLEY PA
Provider Business Mailing Address
First Line : 4791 S MAIN ST STE 100
Second Line :
City : ACWORTH
State : GA
Zip : 30101-5324
Country : US
Telephone Number : 404-251-1600
Fax Number : 770-422-2340
Provider Business Practice Location Address
First Line : 4791 S MAIN ST STE 100
Second Line :
City : ACWORTH
State : GA
Zip : 30101-5324
Country : US
Telephone Number : 404-251-1600
Fax Number : 770-422-2340
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2011
Last Update Date : 10/27/2017

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Directions to “ MR. MICHAEL VICTOR SHIBLEY PA” Practice Location

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