Healthcare Provider Details

I. General information

NPI: 1407712409
Provider Name (Legal Business Name): MICHELLE SHIRAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 E LAMAR ST STE 1
AMERICUS GA
31709-3781
US

IV. Provider business mailing address

155 BALMORAL DR
LEESBURG GA
31763-7506
US

V. Phone/Fax

Practice location:
  • Phone: 229-928-4755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN258814
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: