Healthcare Provider Details

I. General information

NPI: 1104888130
Provider Name (Legal Business Name): MICHELE W CAHILL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN MICHELE WOODS CAHILL CRNA

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 12/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 ELMA G MILES PKWY
HINESVILLE GA
31313-4000
US

IV. Provider business mailing address

18 MCQUEEN STREET
LUDOWICI GA
31316
US

V. Phone/Fax

Practice location:
  • Phone: 912-369-3647
  • Fax: 912-369-3647
Mailing address:
  • Phone: 912-369-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN067957
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: