Healthcare Provider Details

I. General information

NPI: 1710099429
Provider Name (Legal Business Name): MICHELLE YVONNE PERRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 DAN PROCTOR DR SUITE 1800
SAINT MARYS GA
31558-3894
US

IV. Provider business mailing address

2060 DAN PROCTOR DR SUITE 1800
SAINT MARYS GA
31558-3894
US

V. Phone/Fax

Practice location:
  • Phone: 912-510-7376
  • Fax: 912-510-7377
Mailing address:
  • Phone: 912-510-7376
  • Fax: 912-510-7377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number53017
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD0000036799
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: