Healthcare Provider Details

I. General information

NPI: 1235395039
Provider Name (Legal Business Name): MICHELLE GAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10854 PALADIN DR
HAMPTON GA
30228-3340
US

IV. Provider business mailing address

10854 PALADIN DR
HAMPTON GA
30228-3340
US

V. Phone/Fax

Practice location:
  • Phone: 678-817-3174
  • Fax:
Mailing address:
  • Phone: 678-817-3174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN161738
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: