Healthcare Provider Details

I. General information

NPI: 1700267655
Provider Name (Legal Business Name): MICHELLE BYRON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 LINCOLN PKWY E STE 120
ATLANTA GA
30346-2209
US

IV. Provider business mailing address

1455 LINCOLN PKWY E STE 120
ATLANTA GA
30346-2209
US

V. Phone/Fax

Practice location:
  • Phone: 678-824-6590
  • Fax:
Mailing address:
  • Phone: 678-824-6590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN185181
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: