Healthcare Provider Details

I. General information

NPI: 1609905959
Provider Name (Legal Business Name): NIA MICHELLE SIPP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 08/11/2022
Certification Date: 08/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 CHEROKEE AVE SE
ATLANTA GA
30315-1417
US

IV. Provider business mailing address

733 CHEROKEE AVE SE
ATLANTA GA
30315-1417
US

V. Phone/Fax

Practice location:
  • Phone: 410-409-2348
  • Fax:
Mailing address:
  • Phone: 678-631-7993
  • Fax: 404-759-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number46867
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number88273
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number61347
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number61347
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number46867
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number88273
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number61347
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number88237
License Number StateSC
# 9
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number46867
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: