Healthcare Provider Details

I. General information

NPI: 1407712409
Provider Name (Legal Business Name): MICHELLE SHIRAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 ROUNTREE DRIVE SW STE A
DAWSON GA
39842
US

IV. Provider business mailing address

771 ROUNTREE DR SW SUITE A
DAWSON GA
39842
US

V. Phone/Fax

Practice location:
  • Phone: 229-270-1905
  • Fax: 229-270-1915
Mailing address:
  • Phone: 229-270-1905
  • Fax: 229-270-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP258814
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: