Healthcare Provider Details

I. General information

NPI: 1104084870
Provider Name (Legal Business Name): MICHAEL EVERETT SHEFFIELD CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5887 GLENRIDGE DR NE SUITE 450
ATLANTA GA
30328-5574
US

IV. Provider business mailing address

PO BOX 420827
ATLANTA GA
30342-0827
US

V. Phone/Fax

Practice location:
  • Phone: 404-303-7703
  • Fax: 404-303-7706
Mailing address:
  • Phone: 404-303-7703
  • Fax: 404-303-7706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number3012
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: