Healthcare Provider Details

I. General information

NPI: 1447906136
Provider Name (Legal Business Name): MICHAEL CHURCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 02/22/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE, MOT 7TH FLOOR BARIATRIC DEPARTMENT
ATLANTA GA
30308
US

IV. Provider business mailing address

550 PEACHTREE ST NE, MOT 7TH FLOOR BARIATRIC DEPARTMENT
ATLANTA GA
30308
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-1414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: