Healthcare Provider Details

I. General information

NPI: 1073809307
Provider Name (Legal Business Name): MICHELE ANN CHEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

484 IRVIN CT STE 110
DECATUR GA
30030-5406
US

IV. Provider business mailing address

455 PHILIP BLVD STE 140
LAWRENCEVILLE GA
30046-8768
US

V. Phone/Fax

Practice location:
  • Phone: 770-962-3642
  • Fax: 770-962-3643
Mailing address:
  • Phone: 770-962-3642
  • Fax: 770-962-3643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN155861
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN-NP155861
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: