Healthcare Provider Details

I. General information

NPI: 1245710144
Provider Name (Legal Business Name): MICHELLE LYNN LEDFORD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE LYNN BOLAND NP

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3193 HOWELL MILL RD NW STE 125
ATLANTA GA
30327-2100
US

IV. Provider business mailing address

2110 POWERS FERRY RD SE STE 302
ATLANTA GA
30339-5015
US

V. Phone/Fax

Practice location:
  • Phone: 470-419-4380
  • Fax: 478-298-7736
Mailing address:
  • Phone: 470-524-1010
  • Fax: 478-298-7736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN213579
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: