Healthcare Provider Details

I. General information

NPI: 1205706603
Provider Name (Legal Business Name): MICHELE LIN PEARCE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WAVERLY DR
FORT MITCHELL AL
36856-4428
US

IV. Provider business mailing address

3 WAVERLY DR
FORT MITCHELL AL
36856-4428
US

V. Phone/Fax

Practice location:
  • Phone: 770-283-0769
  • Fax:
Mailing address:
  • Phone: 770-283-0769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF11250184
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: